Medication Reconciliation Meets Patient Safety: Do Patients Follow Our Instructions?
Few would dispute the fact that many patients do not fill their prescriptions and many do not take medications as prescribed. Indeed, I have always suspected that most patients, when asked about their current medications, remember the drugs they actually take, or at least what problem those drugs are intended to treat, but generally do not remember the drugs that they don’t take.
Pardon the tautology, but patients are people too. Oh sure, there are some folks who would take the kitchen sink if we prescribed it; even if they don’t recall the exact name of each drug, they clearly know how many times per day they swallow pills and which pills must go down an-hour-and-not-a-moment-sooner before eating; which ones go along with food; which ones cannot be taken with grapefruit juice; and which ones need to be taken while standing on one foot. And then there are those rare, treasured patients who know the names of all of their drugs and all the dosing information to boot.
Yet we need to recognize there are usually very good reasons why patients do not take certain drugs, and these usually have nothing to do with “dissing” us as practitioners. It would also behoove us to let go of the notion that we “put patients on medications.” Patients take medications only if they decide to do so. We can only be influencers in the process.
Some medications do carry nasty side effects, which doctors may shrug at or gloss over, but patients usually take notice of these and respond accordingly. Other medications, while without obvious adverse effects, do not seem to do anything discernible, such as blood pressure agents, so patients may be less inclined to pop them regularly.
Drugs that are directly associated with relieving a symptom, such as heartburn or itch, may be favored, and drugs that produce a pleasant sensation are often the first ones patients remember when asked about medication lists. I have noticed that most patients have no trouble remembering Ativan (lorazepam) and understanding what it does, followed closely by Vicodin (hydrocodone/acetaminophen) and Viagra (sildenafil). I didn’t train in the era of Ambien (zolpidem) and Lunesta (eszo-piclone), so don’t ask me to explain their mechanisms of action; however, I know a good nap when I see one—and I have observed that most patients, spying the noisy nursing station on admission to the hospital, are diligent about recalling these brands when medication-list inquiries are made.
So, to try to improve compliance with respect to all necessary medications, can we do a better job of explaining such unsexy topics as afterload reduction, anticoagulation, and asthma-attack prevention to patients who may already be overwhelmed with symptoms and not understand why they are taking an agent that may actually make them feel worse? cialis canadian pharmacy
Isn’t the burden on us to do so?
Might this not have more to do with improving patient safety than just making sure that our lists on admission are “reconciled” with our lists on transfer of care to other settings?