Let me hear that Jingle.
By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.
In a recent nation-wide poll it was revealed that medication errors occur much more frequently than anyone expected. That did not surprise me one little bit, and I was relieved to read that most “errors” do not result in permanent adverse effects. If you take a real close look at things, it turns out that the definition of “error” was a loose one. It turns out that many primary care physicians have difficulty keeping track of what their patients are taking. There is plenty of good reason for this, but it mostly comes down to just too many assumptions being made within a frail, non-communicative system. I decided to take a closer look to see what could be done. Conducting investigations as a Provincial Coroner allows me the privilege to enter the place of death and review medications. I am recurrently awestruck by the number of medications I find in the homes of persons with multiple health problems. It is easy to fill evidence bags with dozens of prescription and non-prescription medications. Expired drugs, empty vials, salves, vitamins, and balms, similar medications derived from multiple sources and even other people’s prescriptions paint a recurring theme. This is sometimes punctuated with mail-order miracle cures and unlabeled secret vials from unlicensed sources.
The people most at risk are patients with multiple health problems whose well-being depends on seeing a team of health professionals. Most doctors I know try to review what medications their patients are taking at every visit. When I ask someone what medications they are on, it is a bit of a trick question because I am really checking whether they understand what it is they are taking and why. The top five WRONG answers to this question include: 1. The white, blue, white and yellow pills. 2. You should call my daughter and find out. 3. I stopped the little ones, and ran out of the round ones. 4. “They” didn’t tell you? It should all be there in my chart. 5. I take water, pressure, pee and happy pills.
I encourage patients to make my day. Let me hear the jingle of those pills bouncing around in those containers. Bring all your pills including non-prescriptions to the visit. Large Tupperware tubs were invented for this very purpose. There is a lot of information on those bottles. It informs me what your are taking, where you got it, how often you should take it, who prescribed it and how many repeats. I can then review the purpose; side effects and necessary testing that should be performed. It is also a type of quality assurance that ensures the contents of the bottle matches the original intention of the prescriber.
It is inappropriate for doctors to be giving indiscriminate repeats. I generally attach repeats to prescriptions. When they run out it is a signal that it is time for some type of monitoring or medical intervention. Sadly, I recognized that information flow in our medical system is in a critical state of disrepair. Your family doctor quarterbacks the care received from multiple specialists. In some cases, a specialist will commence a new medication for trial or otherwise and will see the patient in follow-up. They remain responsible for the prescribing and monitoring of such medications until this care is transferred verbally or in writing to another doctor. It is unwise to ask an unfamiliar doctor to renew medication on a routine basis. Occasionally it is necessary due to holiday or illness. In this case we tend to prescribe just enough to get you through. I usually add that the regular physician is on holiday to my scripts, since it helps the regular doctor understand how my name got on the label of their patients medicines.
My office seems to get bombarded by faxes on a daily basis from pharmacies looking to sell additional repeats to my patients. Pharmacists are highly trained professionals who are familiar with the actions, doses and side effects of medication. They are able to substitute products and spot mistakes, but their ultimate livelihood depends on moving product. Doctors differ in the frequency of monitoring health conditions often due to time demands. Often, the faxes ask for prescriptions to complete strangers, relatives or people last assessed years earlier. Renewing narcotics by fax is also a big blunder. The other misunderstood and dreaded form is the “LU” request. In Ontario, we have a Drug Benefit Plan that may cover the costs of some drugs under certain and specific conditions, which must be well documented. There is almost a lottery type mentality to this at times. There are enough family doctors closing practices as it stands. We cannot afford to have the others lose their licenses, by asking them to “doctor” the guidelines.
Get rid of those old medications or put large X’s on the ones you don’t use anymore. At least carry a complete list of all medications, doses, who prescribes them and hand an updated version to every doctor you see, especially if you end up in hospital. But best of all, become an active partner in your healthcare and let me hear that medicine bottle jingle when you come to see me! I close with an election plug. The growing scarcity of Canadian trained doctors is the top issue in my mind. Tackling the problem is a six-year ordeal that that scores no goody points for governments with four-year mandates. Please raise the issue with every candidate you meet, Asses their answer and vote accordingly. Our children’s future lies in the balance.