Chronic disease prevention and management in central coastal CA

New patient friendly medication for anticoagulation described with respect to challenges of patient education

I saw a 60 year old woman in the office this week who told me she had a heart condition since childhood and that she was very leery of taking chronic medications, mostly seeking out holistic, naturopathic ways of self treatment.  And in general her condition was not disabling.

Upon exam I detected atrial fibrillation which may have been treated with anticoagulants in her case in the past, to prevent a stroke, but presently she was on no blood thinners.  Not even aspirin.  As we talked it became more clear that she was very hesitant of many common medical interventions including PAP smears and mammography.  I’m sure I do not have the whole story yet, after only one 15 minute encounter.

I have attached to this post a podcast describing a newly available anticoagulant, dabigatran, which has the potential to really change the current management about anticoagulation, which is very doctor-centric, and could really change the locus of responsibility, to prevent stroke, to the patient.  This podcast points out to me the struggle with releasing that responsibility, and in a bigger sense the challenges our profession will need to overcome with the adoption of  Patient-centered approaches.  The below URL will take you to the article and podcast



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