I usually make this folksy comment to invite patients to be active participants in deciding their care, but what was I doing in this situation? Was I sharing decision-making power or was I abdicating responsibility? I reasoned that, since she had already had septic arthritis, she understood the risk she was taking.
I told her that I didn’t agree with all of the assumptions that she had used to make her decision, but by resuming her medication, she spared me an agonizingly tough decision. I don’t think there is any great scientific evidence we can refer to in this situation. This is a gray area that is way off the treatment algorithm, and our only compass is anecdote and clinical judgment. I agreed to refill her medication since she had done well for about 4 months, and she understood the risks. Maybe I should have a special coin to flip for making these tough decisions.
Drug companies regale our patients with remarkable testimonials about the efficacy of their products. These medications work so well that many patients want to resume their medication even after life-threatening infections, but for some reason the ads don’t usually mention that detail. What a marvelous "reality commercial" that might make. "My biologic almost killed me, but I begged the doctor to put me back on it because it worked so well!" If any drug company would like to help me launch a second career in advertising, please drop me a line. It could be the start of a beautiful friendship.
Dr. Larry Greenbaum is a rheumatologist who practices in Greenwood, Ind.