Activated patient, nurse, with engaged doctors. Can’t reliably manage meds?!

How can this be so difficult?

  1. Prescriptions that the doctor writes but that never get filled, for instance because insurance wouldn’t cover it (extremely common) or because it was out of stock (increasingly common in the US and rather distressing, the pharma supply chain for low-profit-margin generics is broken and we are not allowed to import them to fill shortages, even if we see them a thousand miles in advance as the warehouses slowly empty out). Or because the patient just didn’t fill it, perhaps because they didn’t have enough money (also common) or because it was an e-fax sent to a pharmacy that the patient hasn’t used in 3 years and they didn’t know it existed. Should these show up in the list? Or should they get added when filled and picked up?
  2. Medications get stopped without necessarily being documented, and many doctors are used to stopping medications in this way. Many physicians feel that a sufficient way to stop medication X for patient Y is to say “You should stop taking medication X now, and you should tell your PCP that this is why, or I am sending your PCP a secure email, or similar.” If patient Y seems competent enough to understand this instruction, then this is a reasonable and common way to stop a medication. The patient was notified. The original prescriber was notified. But when did it go into the authoritative medication list? That can’t even happen at the pharmacy, like the one above.
  3. Patients are handed lists of medications to check “taking”, “not taking”, or “needs refill” when they arrive, but for many patients these lists are huge and they just don’t read them. Or they check “taking” on the wrong dose of Lipitor, but the right dose of Lipitor was farther down on the sheet, or on the next page, and they checked “not taking” for it. They take five pills, they checked “taking” five times, and therefore all the remaining checkboxes are “not taking”.
  4. When doctors enter a new prescription in an EHR, it pops up a huge number of potential interaction warnings and the doctors just get accustomed to dismissing every single warning because they are false positives 99% of the time. The EHRs cry wolf very, very badly. The doctors click “dismiss” so fast, they may think, “wait, did that say something unusual? I thought that was the QT prolongation warning, which is idiotic, but I think it said something about CYP2D6? Am I giving this patient a CYP2D6 inhibitor? Can I bring it back? No? Oh well, it was the QT warning.” I have seen my dermatologist get a warning popup about C. diff that might be caused by my topical clindamycin, which is idiotic. I put it on my face, I don’t swallow it.
  5. The potential privacy concerns are very large, especially now that life insurance companies are denying people coverage for taking HIV pre-exposure prophylaxis (PrEP) and SSRI antidepressants.

Related posts



Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store