Case Studies

Chapter 20: Communicating with patients about medicines

A 67-yearold woman has been diagnosed with hypothyroidism.

• 1. What information should she be given about thyroxine replacement therapy?

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  Model answer: The medicine is called levothyroxine. It is taken by mouth once a day. Lifelong treatment will be needed.
  It acts by replacing the hormone that her body is not producing enough of.
  Start with a low dose and increase depending on blood tests.
  Blood testing is needed, initially more often, but annually thereafter.
  Possible side effects, including when to contact the GP (increased angina, palpitations, diarrhoea, nervousness, insomnia).
  May take some weeks to feel an improvement in symptoms.
  No major concerns about interactions with alcohol or other drugs

Three years later, she develops palpitations and is diagnosed with atrial fibrillation. She wants to discuss treatment options.

• 2. What options are there for rate/rhythm control?

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  Model answer: Rate control – beta blockers, rate limiting calcium channel blockers.
  Rhythm control – DC cardioversion, anti-arrhythmic drugs (e.g. amiodarone, flecainide).
  What options are there for stroke prevention?
  Anticoagulation with warfarin or novel oral anticoagulants

• 3. Which skills are needed to present these options and facilitate shared decision making?

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  Model answer: Establish rapport.
  Establish the patient's preference for information (e.g. amount and format).
  Outline choices and the evidence for the medicine as it applies to the patient – this can include visual aids, absolute numbers rather than descriptive terms, and so on.
  Help the patient reflect on and assess the impact of alternative decisions .
  Identify and respond to the patient's ideas, concerns, and expectations.
  Negotiate a decision .
  Agree on an action plan and complete arrangements for follow up