It’s scary but true: You have a 2-in-5 chance of being affected by a major medical complication in your life. Even the best health care providers using the most cutting-edge technology can’t prevent it. Yet the same smart people who would never let a stranger make all of their financial decisions (not even Warren Buffet), willingly cede all control of their health to others during a routine hospital or office visit. Health care has become so complex, it’s no longer possible for any one health care provider to manage the whole process to ensure that a patient gets the most effective care…unless the provider has a partner. And that partner is you.
Inside modern medicine
When my kids took me to show-and-tell and the class asked, “What does a doctor do?” I gave the long answer—about lub-dubbing hearts, rubber hammers, and how we’re detectives looking for clues. But on some days, it feels like a shorter answer would nail it. “These,” I might say while holding up a prescription pad. “We write lots of these.”
Meds. If ever there was a love-hate relationship, health care providers have one with meds. How could we not? Doctors and nurses hand out prescriptions in nearly two out of every three patient visits, and more than half of all patients are taking at least two drugs. We’re blessed to have drugs that save patients we would have lost just a few years ago. That’s the love. But the way medication gets handled by patients and providers alike puts us all at risk. Medication errors kill about 100,000 Americans every year and seriously injure another 1.3 million. That’s where the love ends.
Whether we’re writing a prescription or taking one, it’s not comforting to know that the FDA and our own specialists can’t protect us. If we health care providers have gaps in our knowledge (did we just say that?) we shudder to think how vulnerable patients are. Pharmacology is changing so rapidly, it’s become a minefield on both sides of health care. So how do patients get smart and stay safe when it comes to their meds?
Ask all, tell all
It’s such an obvious question but it’s never asked: “What is this medication for?” I see patients daily—health care pros included—who have no clue why they’re taking a certain drug. All they know is that they explained the problem to their primary care provider, she wrote the scrip, and now they’re taking it. Suddenly, emergency strikes and an E.R. nurse is asking this same patient why she’s taking these anticoagulants, and she says for hypertension. Except she’s not. She’s taking them to offset the side effects of another med. Her primary care provider never explained this, she never asked, and now an ER resident will give her the wrong treatment, assuming a different problem than the one that’s really presenting.
After that cardinal question, and before all the basic dos and don’ts and what-ifs, we always ask—and advise patients to ask—these five oft-forgot questions before taking a scrip:
1. “Are you sure I need this drug?” This is hard for patients because it’s like asking a health care professional “Are you sure you know what you’re doing?” But the looming Armageddon from antibiotic overuse is only one reason to ask. In fact, the med might offer no greater benefits than non-drug treatments such as massage and hypnosis.
2. “Does this med replace or interfere with anything I’m currently taking?” This might seem obvious, but it’s a nice way of saying, “You do remember that I’m taking these two other pills, right?”
3. “How new is this drug?” Your health care provider might forget to mention that it was approved last Thursday after tests on exactly 2,113 people, few of whom had your health profile.
4. “How long have you been prescribing it for my condition?” “Since last Thursday” is not a good response. “Since 1981” is also troubling; there’s likely newer, superior alternatives.
5. “Can this med cause any problems at my age?” If you’re 58 and the drug was tested on (or typically given to) twentysomethings, or you’re bringing Mom or Dad in, you’d better know the answer. A Duke University study found that physicians prescribe drugs known to be dangerous to older people to more than one in five patients age 65 or older. Considering this age group takes 30% of all meds…my calculator just fried, but the implication is terrifying.
Ask the questions and then write down the answers—here’s why: A 2005 study found that people’s memories play a nasty trick: After hearing a clear order—such as “don’t take this pill at night”—subjects remembered key details (such as “pill” and “night”) but not the specific action requested, which invites an easy mistake. Once home, hop on the Internet and research the med at an expert site such as the FDA’s Center for Drug Evaluation and Research Web site
Same white coat, less attitude
Why don’t people get to know their pharmacists? This person has a vast repository of knowledge at her fingertips, can give you an in-the-trenches view on which prescription and over-the-counter drugs work best, and could prevent serious goofs—if she’s asked. But she’s not. The only thing most of us want to hear from our pharmacist is, “It’ll be ready in about 20 minutes.”
Some folks are understandably uncomfortable discussing their health history while standing in line at a mega-retailer; but don’t be shy—pull the pharmacist aside and ask questions. It’s worth it. Pharmacists can also be a good safety backup system. If they know your history, and if they’re doing their job, they’ll ask you about a prescription that seems odd or remind you that taking this drug with those multivitamins you’re also buying could cause internal bleeding. Befriend one at a wired pharmacy that has the latest cross-checking technology, and preferably one that fills prescriptions electronically.
Ask your health care provider to write digital scrips if she’s not doing it already. It’s faster and eliminates errors caused by poor handwriting. It’s also a boon in an emergency; after Katrina, New Orleaners who had digital scrips on record regained lost drugs much faster.
Take your pills—period!
Patients failing to take their medications as prescribed is the most frustrating problem health care providers have with meds. Some two out of every six prescriptions that get written go unfilled, and about half of patients quit taking the ones they fill within six months. Neglecting to take prescribed blood-pressure pills contributes to unnecessary aging of your arteries and is thought to cause more than 30% of all heart attacks. Failure to take cholesterol management drugs almost cost our former President his life.
This is your hospital on drugs
Watch a robotic hospital pharmacist loading drugs at work, and it may seem like something out of a science fiction movie. Robotic arms whip around filling 1,500 prescriptions an hour. (A human checks each one, to keep things from getting too Orwellian.) It gives you a sense of the sheer volume of drugs dispensed in hospital—and provokes a feeling of utter amazement that screw-ups don’t happen 50 times as frequently as they do.
Drug errors kill an estimated 80,000 hospital patients a year, though exact figures are elusive. Providers beg patients to take nothing—nada—for granted when they’re handed that paper cup of pills. So it makes sense that we should also encourage you to ask “Why?” if your hospital I.D. bracelet doesn’t have a bar code or providers aren’t checking your I.D. at each interaction. Ask your health care provider to confirm your last name and compare each pill against their own bedside copy of your Medical Administration Record. It’s not presumptuous. It’s just smart.