Q&A Session with a Pharmacist: Why Patients Are Repeatedly Asked, “What Medications Are You Taking?”
Healthcare Providers, Parents
If you feel like you’ve been asked, “What medications are you taking?” by a nurse dozens or hundreds of times, you’re not alone. So why does every clinician ask that question in every single conversation, and what are they really trying to understand?
We recently chatted with Caleb Dunn, PharmD, DrFirst Product Manager, to discover why he has spent years asking this question of his patients.
Caleb, why are patients repeatedly asked this same question?
Medications are a cornerstone of how appropriate treatment is accomplished. When someone says they are taking Medication A, you can map it back to a previous diagnosis. In general, when you hear about a patient taking a particular medication, you get a view into his or her past. The more medications we account for, the clearer we can see their health condition.
For instance, Gabapentin can be used for seizures, nerve pain, or insomnia. If you see a patient is using Gabapentin and another seizure medication, that strengthens the potential that this patient is using both to manage a seizure disorder. And that provides a guide for your treatment path forward.
But shouldn’t my regular doctor already have my record? Why do they ask about medications every time?
That’s a great question. The reality is that a snapshot of someone’s health today isn’t necessarily going to hold weight with a snapshot of that same person in six months because our health needs can shift so quickly. It’s very likely that someone might go to urgent care one night, the emergency room the next day, and their primary care provider a week later. Those rapid, successive appointments combined with the lack of interoperability (the ability for doctors to share information) necessitates persistently asking about medications.
What if I don’t remember it exactly, but I generally know why I’m taking a medication or what the medication looks like?
Unfortunately, visually describing a medication provides zero value. Imagine if someone says, “It’s white and has a 33 on it.” That 33 could easily be an EE and could indicate a very different medication. In general, appearance does not provide much information.
Justification for why you’re taking a medication is helpful, but again, it’s not enough to identify the medication and provide concrete information to make decisions. If that’s all you have, share it. But if you have more, always share more.
In a perfect world, what kind of medication information would you want from a patient?
I worked in the Emergency Department (ED) overnight, and my favorite people were those who had a printed list with all of their medications, the pharmacy where they were filled, full drug names, dosage directions, and even when they last took the drug. Ideally, it’s best to maintain a list with these details, plus the last date the list was updated. It’s not uncommon for someone to pull a list out of their wallet, but have no recollection of when it was last updated. Knowing that is important because the ED can be a very stressful situation and recollection gets cloudy when you’re stressed.
Can you give us some examples where having a medication list could make a big difference to someone’s diagnosis or treatment?
A very common diabetic medication is Metformin. When you’re taking this drug, it changes the therapy for how physicians do imaging with contrast because there are major concerns for kidney damage. Your doctor might give you a specific treatment that includes additional fluids before imaging if you’re taking Metformin.
Or say someone comes into urgent care with a dry cough. A whole class of medications called “ace inhibitors” is known for having dry cough as a side effect. If the patient doesn’t have their medication list, they may have an unnecessary X-ray of their chest, an unnecessary swab of their nasal cavity, and things like that. They go through unnecessary testing when the most likely culprit is a side effect of the new medication they started last month.
Another example is anticoagulants, or any medication that thins your blood, because they can affect how you’re treated for surgeries or how you’re treated for a stroke. Let’s say you’re having an emergency surgery done and you’re taking Apixaban. If the doctors don’t know that and go into surgery, there will be major bleeding concerns. But if they do know, there might be a reversal agent that can be used. So, it’s very important to say, “I’m on Warfarin vs. Apixaban vs. Dabigatran,” because each one will have a different approach to reversing it in a traumatic experience. This is a prime example of why saying, “I take medications because I have a history of clots” will put up a red flag, but it’s not enough to move forward in terms of treatment. It could even cause a delay in treatment when trying to find more information.
I can’t imagine it’s common for the average person to carry around a detailed medication list. How does that affect treatment and care?
It’s a substantial problem. The scale of risk is very high. In general, medication names are complex, and when someone is taking more than one or two, it gets confusing for them. The expectation is for a patient to know it all off the top of their head, which isn’t right. I’m not an electrician, so don’t ask me about the copper gauging in my house. The same goes for patients and their medications. While patients need to take a degree of ownership in their health, we as providers need to give them to tools to do it easily and efficiently.
Needless to say, medication lists can be lifesaving! If you take medications and want an accurate list to help prepare for doctor’s appointments or emergencies, try Huddle Health. To learn more about using a personal health record like Huddle Health, check out our post, What’s a Personal Health Record?
Caleb Dunn, Pharm D, has a master’s degree in Informatics from Southwestern Oklahoma State University and is a Product Manager and clinical specialist at DrFirst.