There I was, sitting on the exam table, listening to my doctor explain how my handful of pills was going to have to become a larger handful of pills. (Yes, Doctor V as patient.)

I have a chronic medical problem. I'm fine, but I have to take a handful of pills every morning and every evening to stay fine. Unfortunately, those pills have not been working quite as well as we would hope, and the verdict was that I needed to take more. Stink.

So began my negotiations with my doctor. I'm a good and regular swallower of my pills, perhaps because my current life's work revolves around making sure that children are taking the medicines that they need every, single day. I do a lot of thinking about adherence to medicines, and that probably makes it easier to be adherent myself.

Because of my work, it is also very clear to me what I can do well with my own adherence to medicines and what I cannot do well. I can take medicines every morning and every evening. I can swallow however many pills I really need to (although I am slow in my one-by-one swallowing and would be very happy to have less pills to take.) I can do battle with my insurance company about my need to get my prescription a few days early so that I do not miss doses during my many travels.

But what I don't think I can do well is take a medicine in the middle of the day every day. I would have to carry it with me all the time, and I know I would forget that third dose. That's what I told my doctor. "Anything else," I say, every time he brings this up. "What else might work?"

We figured out a compromise that involves more and stronger medicines, but keeps me taking my handful of pills just twice a day. Not bad.

I have been left thinking about what my negotiations means for our thousands of patients in Kenya. Here I am, a doctor myself, very aware of the benefits of my medicines, and very committed to taking them well. I can discuss the options with my doctor. I can wrangle with my insurance company over the unnecessary grief they give me in my attempts to make sure I have my month's worth of drugs or to make sure that I get the twice-a-day drug instead of the three-times-a-day drug. I am equipped for this in a thousand different ways.

What does it take to equip our families in Kenya to have these conversations? What would it take to know better what their preferences are -- to know which medicines taste too bad, which pills are too big? To know which families could handle a medicine that needed to be given three times a day and which ones could not? What can we do to change the relationship between doctors and patients to allow space for creating a plan that will work? (No matter where in the world you live or for how long you have gone to school.) How can we equip each family to have that discussion about what they can and cannot do?

Posted at 09:30


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