Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 25 January 2006

MEDICATION PROBLEMS – II

            Last week’s column discussed problems with medication adherence.  It was pointed out that 2 out of 3 people prescribed a cholesterol medication don’t take it after the first year.  While any number of excuses can be offered as to why the medication isn’t used, it seems an old adage really does apply:  “You can lead a horse to water but you can’t make him drink”.

            The Joint Commission for Accreditation of Hospitals has spearheaded an effort to decrease medication errors and improve patient safety.  The thought is that maybe greater drug safety will lead to better patient acceptance of and adherence to their medication prescription.  The effort is called Medication Reconciliation, which for lack of a better explanation, means “getting everyone on the same page”.  The first thing that they recommend is to have a single primary care provider.  Medications should be prescribed by one individual health care provider.  The idea that “too many cooks make a bad stew” certainly applies in medicine.  When one doctor doesn’t know what another one is doing, the potential for medication side effects and drug interactions escalates.  Having one primary care provider know all of your medications and make sure that they are compatible is an important part of medication safety.

            A second safety precaution is to use one pharmacy.  Often patients are shopping from one pharmacy to another to get the best price.  Sometimes medications are sought from Canada or Mexico or from a national mail order chain.  An important secondary safety net is the pharmacists.  Physicians and healthcare providers prescribe medications but they are not perfect and mistakes can happen.  When all of a person’s medications are obtained at one pharmacy, there are computer programs that will pick up drug interactions and prevent side effects or drug hazards.  Using one pharmacy for all of your medications is an important safety precaution.    National surveys have shown that at least 40% of the general population uses some alternative medication, dietary supplement or herbal preparation.  Some of these can interfere with medications that are prescription.  It is important that over-the-counter non-prescription products are reported to your healthcare provider.

            Embarrassment is a terrible thing.  People go to all sorts of measures to avoid being embarrassed about one thing or another.  People get embarrassed about admitting that they are depressed or that they are anxious or that their urine is leaking or that they are using a sexual aide.  It is important that all medications be reported to your primary healthcare provider.  Discussions with a primary healthcare provider are very privileged and not a time to be embarrassed.  Often very personal matters which are discussed with a primary healthcare provider will be recorded in the chart simply as “a private matter was discussed”.  As a patient you can ask that certain private matters not be recorded in your chart.  Of course, this type of entry makes it even more important that a person have a single constant primary healthcare provider.

            In today’s world “second opinions” are very frequently sought by patients.  Speaking for myself, I love second opinions.  If a second opinion agrees with my own, my creditability is enhanced.  If the second opinion doesn’t agree with what I am thinking, it gives me a chance to make corrections if I agree with that second opinion.  Don’t be embarrassed to ask your primary healthcare provider to refer you for a second opinion.  When you do, make sure a copy of that opinion, gets back to your primary care provider’s chart.

            Many primary healthcare providers will provide you with a list of your medications as they know them to be.  This is important because it makes sure that you are both “on the same page”.  Having a copy of your medications with you in your purse or wallet is a useful safety tool.

            Your safety and comfort are the primary directives of your healthcare providers.  An accurate listing of your medications, using a single pharmacist and using a single primary healthcare provider and following medication instructions are all important parts of providing that safety and comfort.  The healthcare providers at your local clinics in central South Dakota may not do brain surgery or replace heart valves but they are very skilled in orchestrating and coordinating your medical regimen.  They use the opinions of referral specialists in addition to a consideration of your own personal profile in arriving at the safest most effective drug program.