What Do Patients Know About Their Medications?

Physicians have great responsibility to protect the health of their patients.  But the practice of medicine is a shared responsibility.  Patients – the major stakeholders – obviously have responsibility for their own health.  In my view, they are charged with questioning and understanding the rationale of proposed medical advice.  I do my best to explain my advice clearly.  If there are reasonable alternatives, then I present them.  But if the patient before me remains unclear on the situation, then he needs to ask me to repeat and clarify.   Patients must exercise personal responsibility.

If a surgeon enters an exam room and tells you that surgery is scheduled for the following morning, I would hope that you would be fully informed on what operation is planned and why it is necessary.  It sounds absurd that a patient would consent to an unspecified surgery. 

"Ready for pot luck surgery tomorrow?"

And yet, I regularly see patients who have no idea why they are taking certain medicines.  (I admit that many of their medication lists are so long, that they would need to carry an Excel spreadsheet with them to keep track!)  I don’t expect patients to know the chemical structure of their medicines, but I do think that they should know their general purpose. 

A few days prior to penning this, I saw a patient taking Eliquis, a potent blood thinner.  This medicine was of interest to me as it would need to be temporarily held before his upcoming colonoscopy.  It wasn’t clear to me from his chart why he required a blood thinning agent, so I resorted to a time-tested method to find the truth.  I asked him. 

He wasn’t sure why he was taking the medicine.  It was prescribed a year ago by his orthopedist at the time of hip surgery to prevent a blood clot, a complication that he thankfully avoided.  In this situation, the blood thinner is usually prescribed as a temporary measure.  I thought that there were 2 explanations to this puzzling situation.

• Through medical oversight, he was never advised to stop the blood thinner.
• The patient needs the blood thinner for another reason not known by him.

I directed him to contact his primary care physician for clarification.  He did so and contacted me back as I requested to explain that he did, in fact, have a cardiac condition that warranted this drug.

So, no foul, but, why didn’t he know this?  Did the doctor fail to inform him?  Did the patient simply forget?  Regardless of where the blame lies, this patient should have known why he was swallowing down a chemical each day.   Look over your own medication list.  Can you explain the medical necessity for each one of them?  If not, might I suggest a time-tested method to find the truth?  Ask your doctor.