ASK DR. BAUGHAN                                      December 26, 1998

WHAT MEDICINES ARE YOU TAKING?

Here’s a peculiar example of our social priorities in the use of technology:  If you faint in any town in the United States, we could take an ATM card out of your pocket and find out your bank balance if we could determine your PIN. We could not, however, determine what medicines essential to your health and survival you were taking.  What’s even more remarkable is that when you woke up, many of you still could not tell the rescue personnel what medicines you were taking.  There are several almost contradictory reasons for this state of affairs.  On the one hand, there is enough trust in the medical profession that many people will take what the doctor prescribes without double-checking what it is and what it does.  On the other hand, many people do not take chronic medicines consistently, anyway, indicating they really do not believe they are really necessary.  Then, of course, it does not help that the names of the medicines are strange, often long, and may be written brand name one time and generic the next in tiny print on the prescription bottle.

Medication errors are a big problem, though, and should be preventable.  They cause billions of dollars of wasted medicines, unnecessary side effects, hospitalizations and sometimes deaths.  Trying to correct the situation requires careful inspection car by car from locomotive to caboose of a long train of events.  Let’s start with the doctor or nurse practitioner.  He or she may make an error in selecting a medicine (hopefully a rarity).  If the provider does not know what medications the patient is taking (either no records or the patient does not know), a medicine might be prescribed that is incompatible with other medicines.  This is particularly common when the patient is seeing multiple providers in different offices or emergency rooms, and there is no common record keeping system.  Even with a computerized record system such as I have in my office, it is difficult for human beings to be consistent in recording medicines accurately or in accessing the information without errors.  Medications are changed or doses adjusted on phone calls or by doctors on call, and the changes might not get recorded.  Handwritten prescriptions may be illegible (No, really?).  Even if the medicine is legible, the instructions might not be.  The standard abbreviation for “once a day” is “qd” - for “four times a day” is “qid.”  As a student I was chastised by a senior resident for writing “four times a day” because it was not “professional.”  Medicines can sound alike and look alike when written.  Prilosec (an ulcer drug) was originally called Losec, but was so often mistaken for Lasix (a strong diuretic) that the company changed the name.

Then the pharmacy.  Pharmacies are getting much better in computerization and keeping records of medications, but patients do not always go to the same pharmacies.  Pharmacists are people, too, just like doctors (No, really?  Yes, I hate to expose the myth), and medication might be dispensed in error.  A relatively recent but growing phenomenon are the mail-order pharmacies where there is no person-to-person confirmation of medicine and dose.  With mail-in prescriptions and HMOs, often medication substitution of “interchangeable” medications may occur with or without the doctor’s knowledge.  Most of the time this may be harmless, but not always.

Next, the patient may or may not take the medicine.  Over-the-counter medicines, nutritional supplements, herbal products, etc. may have potent effects, but patients may not think of them as “medicine.”  Patients may save old medicines that helped sometime in the past and self-medicate when they are feeling sort of like they felt when they took the medicine before.  There have been numerous studies that document that geriatric patients commonly share medication - “Here, this worked for me, give it a try.”

How can we prevent or at least minimize medication errors?  Record keeping can improve.  Someday in the distant future, medical records in different offices may be linked together.  Patients can make more effort to remember their medicines, names and dosages.  Keeping a list in your wallet or pocketbook is very helpful.  One of the very best ways, though, is to take all your pills, capsules, lozenges, powders, potions and elixirs to your primary care provider at every visit.  Then he or she can lay eyes on the labels for names, dosages or ingredients.  I have a sign in every exam room asking patient to bring all their medications to every visit, but most still do not.  Maybe this column will reach a few more.  PLEASE, FOR THE NEW YEAR, BRING IN ALL YOUR MEDICINES.  BRING THEM IN A SHOPPING BAG.  BRING THEM IN A GYM BAG.  BRING THEM IN A SUITCASE.  JUST BRING THEM.  BRING THEM ALL.  What would it be like to have a whole year without a medication error?  Let’s give it a try.  The days of, “I take a pink and a blue pill,” deserve consignment to antiquity.  Medicines are potent and the names and dosages are important.  Let’s do our best to know what they are.