Doc’s Box
Dear Neighbors,
I remember one of the first things we learned as medical students was the phrase “primum non nocere” -- “First, do no harm.” This principle of non-maleficence is echoed in the Hippocratic Oath that many medical students around the world take when they don their white coats for the first time.
While the medications that we prescribe are intended to be of benefit to our patients, research has demonstrated that medication sideeffects and adverse effects (unintended negative effects) account for a staggering number of ER visits, complications, harm, and deaths each year. It is estimated that adverse drug events (ADEs) account for 700,000 emergency department visits and 100,000 hospitalizations annually (source: AHRQ.gov). Notably, as many have seen on the news, opioid-related deaths are an example of this trend, and I will dive deeper into opioids in next week’s article.
So what can be done to help prevent ADEs? Here are some tips:
Bring all of the medications you take -- including supplements and vitamins -- to every clinic appointment.
Keep an active list of your current medications with you at all times. Update this list with each medication change. You can do this on many smartphones (https://support.apple.com/en-us/HT207021)
Ask your healthcare provider to update your medication list at each visit in the electronic medical record.
Ask for a print out of your healthcare provider’s medication list and compare it against your own. If there are differences between the two lists - make sure you have clarification and get on the same page! It may be that you or your physician are not aware of a medication change or discontinuation. This could lead to taking too much of a certain class of medication or an interaction between two medications.
Discard medications that have been discontinued or completed with your pharmacy.
If you are seeing several healthcare providers and feel that each is not aware of all of the medications you are taking, request that all of your healthcare providers send records to each other. Also ensure you have an up-to-date medication list to take to each appointment (see above). This may help decrease the risk of having medications that interact.
If you take medications to lower your blood glucose (such as insulin), medications to thin your blood (such as aspirin or warfarin), opioids, or benzodiazepines you have a much higher risk of having an ADE and should communicate with your provider if you notice any side effects with these medications and strategies to minimize doses of these medications.
In all, medications are meant to cure, and I hope that you gain the most therapeutic value out of them! For more information see https://psnet.ahrq.gov/primers/primer/23/medicationerrors
Be Well, Friends, Dr A.
Doc’s Box is a weekly column written by Shiv Agarwal, MD with Global Family PracticeSM, pLLC as well as other colleagues. Any medical opinions in this column are general and should not be adopted without first visiting and discussing with your Family Physician. To protect your privacy and personal health information, please direct your health questions to your personal physician during a scheduled office visit in lieu of writing in to the column. To schedule an appointment with Dr. Agarwal, reach his scheduling team at 940-567-5528.