How Dr. Jones Determines the Best Meds

I have been prescribing medication since 1966. It is as much an art as it is science. When starting someone on a medication, I tell them, “I am not looking for you to say”, “doctor I think it is helping some.” What I’m looking for is “this medication is great! It has made my life better and it’s not causing any significant side effects.” Surprisingly, this is a fairly common response after a week or month or two. The harder challenge and the main goal I have is for a patient to be still saying that in 6 months, 1 year, 2 years or as long as needed. This is a much tougher test and only a few medications consistently live up to that standard. For most medications it is at best a trade off-some definite benefits but also annoying side effects.

The main factor that I use in ranking medications is my clinical experience. Everyone of my patients becomes a teacher-how does this medication help, what side effects does it have, how much difference does it make in their life, do their loved ones agree that they are doing as well as they think they are? I’m not just interested in how they feel overall, but even more importantly, how do they FUNCTION?
Many doctors get skewed feedback because the patients that don’t like the treatment just don’t come back. The ones that come back feel like the treatment is helping and so the perception is this is a good treatment. Managed care especially likes the patient that doesn’t come back. This is counted as a “one treatment cure”.

So what medications have the best batting average? This translates to what are the odds that I’m going to think this medication is great-both short term and long term?

The best medications consistently work great, have minimal side effects, and work as long as they are needed-which may mean indefinitely. I am especially biased because I don’t participate in any managed care programs. I have to get good results to keep my practice going.