Does your medicine cabinet look this neat?
Do you even have this many drugs?
My “medicine chest” is in my kitchen. Various and sundry medications and supplements share shelf space with Skippy Extra Chunky Peanut Butter, Smucker’s jelly, Starbucks coffee, Splenda, and CoffeeMate.
I’m ready for nasal congestion, runny nose, nausea, muscle spasms, inflammation, cough, insomnia, diarrhea, indigestion, allergic reactions, superficial boo-boos and headaches.
If I had the appropriate anatomical equipment, I’d probably be prepared for erectile dysfunction.
And those aren’t even my prescription meds!
Oh, I don’t take them all, but just in case someone has a symptom, I am ready!
Better living through chemistry, that’s my motto!
Now that the asinine medication reconciliation sheet is an asinine intimate part of the medical record, it’s time to look past the inconvenience, the increase in paperwork and the loss of time at the bedside.
The bottom line is that when you are admitted to the hospital, you are writing your own prescriptions.
The medications you state you take, in the dosages you provide will be ordered, based on the medication form.
This is good, yes?
Only if you are dead certain of what you are saying. Only if you are not writhing in pain and are with it enough to remember all your medications. All of them. Only if you are absolutely certain of your dosages. Only if the list you “always carry” is up-to-date.
If not, then you run the risk of not getting your usual medications in the hospital, getting medications or dosages that were not part of your daily routine or new medications that interact with your old ones.
The whole point of the med rec form is to provide continuity between your pre-hospital, in-hospital and post discharge medication regime.
This wasn’t necessary back in the days of “Marcus Welby, MD”, when your primary doctor followed you in the hospital. She knew you well, knew your family, knew your medical history. Your medical record was the chart in her office, to which she always had access.
Today, you will most likely be admitted by a hospitalist who will coordinate your care and have (possibly multiple) consultants who will deal with specific medical issues. These doctors may or may not know you, and they rely on what is written on the medication sheet to guide their ordering.
They will base your medications on that and they will use the med sheet to avoid medication interactions when they write new orders.
- That means, if you can’t remember your medication dose, and you guess at it, that guess becomes your dose. Maybe it’s right, maybe not.
- That means that “I take a water pill, a blood pressure pill, a sugar pill and a stomach pill” will pretty much guarantee that your usual medications will not be ordered, at least in the beginning.
- That means “my doctor has a list of all my meds” means nothing after office hours because (a) the office is closed and (b) your doctor is probably not on call and trust me, the on-call doc is not going to go to the office and look you up right then and there.
This means that in this day and age, you better have a list, it had better be accurate and it had better be up-to-date and in your wallet (not your wife’s purse or your husband’s papers) at all times.
You would be stunned at the number of alert, oriented, intelligent adults who honestly have no clue about their medications or are so stressed on admission that they cannot remember clearly.
The vast majority of physicians will move hell and high water to find out what you are taking and order appropriately. Then again, some will take that med rec sheet so literally that all they will do is check the “order” box next to what is written: medication names that you provided and medication dosages that you stated
So, it is to your advantage to make it as easy as possible for your hospital health care providers to make sure you receive the appropriate medications.
The majority of this responsibility is now on you, the patient.
Not the doctor. Not your family. Not the paramedic who has to go through your medicine chest.
Make a list of what you take, keep that list up-to-date and keep it with you at all times.
I know it sounds crazy, but under the medication reconciliation requirement, you are essentially writing your own prescriptions when you are initially hospitalized.
Make sure you know what they are.
You health, and your life, may depend on it.
Major hat tip to my (very) esteemed colleague who actually had the idea for this post and graciously let me use it!