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Let Me Hear That Jingle
(Prescription and
Non-Prescription Medications)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 15 in the March 21-22, 2009 issue of
The Mississauga News under the Feature: Health, Wellness & Beauty, Medicine Matters
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

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 are many good reasons 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 some patients 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.

Make your doctor's day. Let your doctor hear the jingle of those pills bouncing around in those original 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 of what you're taking, when and 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. When your repeats run out, it is often a signal for some type of monitoring or medical intervention. Sadly, I recognize 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. The specialist remains 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 a 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 his or her patient's medicines.

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 a 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!

Related resources:

The Most Common Medication Errors from MedicineNet.

Consumers Can Prevent Medication Errors from Institute for Safe Medication Practices (ISMP). Include: Throw away your medicines safely, General Advice on Safe Medication Use, Preventing Drug Errors in Children, Brochure on Safe Medication Use, Safe Medicine, the ISMP Medication Safety Newsletter for Consumers.

Strategies to Reduce Medication Errors by Michelle Meadows, from U.S. Food and Drug Administration. How the FDA is working to improve medication safety and what you can do to help.

Simple Strategies to Avoid Medication Errors by Russell H. Jenkins, MD, and Allen J. Vaida, PharmD, from American Academy of Family Physicians. Safe medication use is achievable and affordable if you follow these recommendations.

Preventing Medication Errors (Quality Chasm Series). Report finds that medication errors are surprisingly common and costly, and outlines a comprehensive approach to decrease these errors.

Medication Errors from WrongDiagnosis.

A Guide to Safe and Effective Medication Use: What You Can Do to Help Prevent Medication Errors from Aetna.

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