The importance of getting and taking medical advice

About one year ago, a senior hospital official stated in a newspaper interview that non-compliance with medication was the cause of increased patient visits to the Accident and Emergency (A&E) Department at the Queen Elizabeth Hospital. This, the official explained, was the reason why the A&E Department was being overwhelmed with patients. This claim was made without supporting data, and no solutions to this problem were offered by this official.

While I also do not have any national data on this (and our Chief Medical Officer has not produced the annual CMO’s report since 2012), I offer a different vantage point—that of one who works at the frontline of our healthcare system.

In medicine, compliance—also referred to as adherence—describes how well patients follow medical guidance, including medication regimens, diet, exercise, and other therapies. By necessity, most of this occurs without the direct scrutiny of medical officials, but inappropriate behaviours often have health consequences.

While following medical advice may seem straightforward, non-adherence is a complex issue with serious consequences, especially for chronic conditions like hypertension and diabetes. Poor adherence can lead to emergency room visits, strokes, heart disease, dementia, and even death. Skipping your medications is like ignoring the warning light on your car—until it breaks down.

If, in fact, non-compliance is the main reason that patients flock to the Accident & Emergency Department, and to the number of Emergency Clinics that have sprung up across the nation in the last couple of decades, it seems that a philosophy of ‘health promotion and disease prevention’ has been replaced by ‘we can patch you up once you get damaged’.

Our nation’s health depends on shifting from emergency care to everyday wellness. Healthy living must become the first line of defence—not the last resort.

Many persons believe that going to a doctor should be reserved for situations when you are sick. This should be the designated role for the Emergency Physician.

Unfortunately, many of the illnesses that dominate our health landscape, specifically the chronic non-communicable diseases and many cancers, are ‘silent’ for long periods. They quietly do their damage in the background, and only ‘break the silence’ when the disease process is advanced, such as when a heart attack, stroke or advanced cancer ‘shows itself’. The silent phase of many conditions often offers the best (and sometimes the only) opportunity for early detection and successful intervention. An ounce of prevention is better, and generally way cheaper, than a pound of cure. When one ‘feels sick’, it is often too late to reverse the disease process.

Our health services perhaps need to focus on health promotion and disease prevention, rather than on Emergency Care. Emergency Care depends on you getting sick, and rarely offers the opportunity for a complete disease reversal.

The lack of healthy eating and healthy exercise are included in the main list of risk factors for chronic diseases, the NCDs. While the appointment of a National Physical Activity Commission a few years ago suggested that a national ‘Action Plan’ was about to be rolled out, the commission instead went into early onset demise, even after research data from the Health of the Nation study suggested that 75 per cent of our adult population did not get sufficient exercise to preserve health, and this seemed to be a major contributor to the NCDs.

Also on the list of chronic disease risk factors is the use, if not the abuse, of alcohol. We lament the victims of motor vehicle accidents triggered by drunk drivers. We lament the persons whose mental acumen has been permanently degraded by prolonged alcohol use. On the other hand, we embrace the international recognition that comes with locally producing one of the finest alcoholic beverages. The national drink of Barbados is rum (although Google lists it as rum punch).

We also note the large number of calypsos that promote alcohol consumption—every year—as we look forward to our national festivities. Rum drinkers and supporters of West Indies cricket have been having heated discussions about where ‘the best shot of the day’ actually takes place.

We are concerned about the rising number of mental health cases (and the consequences, including the violent ones) that may have reached epidemic proportions. At the same time, we are embracing a medical cannabis industry, with limited safeguards, and at best a promise that more mental health officials will soon be employed.

At best these represent official ambivalence to chronic disease and mental health prevention. With this background, it is no surprise that the A&E Department, as well as our Psychiatric Hospital, is over-run with patients.

The progression of the NCDs and mental illnesses can be slowed, if not reversed, by focusing on the ‘risk factor’ stage, rather than the ‘disease complication’ phase, as the A&E Department and the Emergency Clinics do. The nation’s health status should not be held hostage by persons who decline (for whatever reason) to follow appropriate medical advice, particularly in taking medications and limiting drug use; instead the focus should be on preserving health so there is a reduced need for medication and emergency treatments in the first place.

The American Heart Association describes “Life’s Essential 8”, as key measures for improving and maintaining cardiovascular health. Better cardiovascular health helps lower the risk for heart diseases, strokes and other major health problems. These measures include healthy eating: drinking more water, reducing the intake of sugar-sweetened beverages, and consuming more fruits and vegetables.

Eating less food that is too sweet, too salty and too oily is important; this description can be applied to much of our commercial foods. For those over 35 years, the national dish is half rice, half (macaroni) pie, and stew; for those under 35, it is probably a snack box, a hamburger, a roti or a couple of pizza slices, along with a sweetened beverage.

The Health of the Nation study said that 90 per cent of adults in Barbados do not consume nutritionist-recommended quantities of fruits and vegetables. More recent medical research suggests that we should limit our consumption of red meat—both from a cancer prevention point of view and to reduce the ecological damage associated with meat production—and try to eliminate trans fats from our diets.

Even though small amounts of trans fats occur in foods like meats and dairy products, most trans fats are found in a variety of processed and fried foods that fill our supermarket shelves. They are often present in baked goods, and some types of margarines and shortenings. Unfortunately, from a health point of view, manufacturers make processed foods addictive to generate more sales.

Other measures include getting regular exercise; avoiding smoking; limiting (or even better, eliminating) alcohol; getting healthy sleep; controlling your weight, blood pressure, blood sugar and cholesterol. The latter measures can be more effectively done with periodic supervision, as they can (and often do) silently lead to the deterioration of personal health and a collection of serious diseases.

Staying healthy is thus an individual choice, complemented by a periodic health evaluation (“check-up”) to mitigate any disease ‘risk factors’, before they progress to full-blown disease. Each individual should make a concerted effort to embrace healthy lifestyle options and follow the advice of his/her family physician.

Since many people rarely see a doctor, by choice, or are turned off by long waiting times at the government health centres, they may not be fortunate enough to get medical advice, and hence cannot be accused of being non-compliant. This provides fertile ground for ‘silent diseases’ to ferment, and may be part of the explanation why we have such a high prevalence of these non-communicable diseases.

Ultimately, building a healthier nation requires more than diagnosing illness—it demands nurturing wellness. When individuals actively engage in preventive care and consistently follow sound medical advice, we shift the focus from crisis response to proactive living. This transition will not only alleviate the burden on emergency services but foster a culture of vitality, resilience, and personal responsibility. The future of public health depends not on how well we treat disease, but on how deeply we commit to preventing it.

Dr Colin V Alert is a family physician and former researcher with the Chronic Disease Research Centre.