Field Notes: The deceptively dangerous thing many people do with their medications.
Please don't do this...(And also, one thing you absolutely should do!)
In the ER, we are often starting from scratch. We are given no information about the past medical history of the patient being rolled in on a stretcher. Other times, we have the opposite problem. Here are the two extremes:
Extreme #1: “We got nothing.” The triage nurse rolls a patient into the ER who has never been to our hospital, or anywhere in our medical system. The patient has no ability to tell me their medical history, or even why they’re there. A classic scenario might be a family who went to visit an elderly relative. “Grandpa doesn’t look right.” So, they loaded him into the car and took him to the ER, hoping we could help. When the family sticks around, they’re usually extremely helpful. When they don’t, we’re often adrift, at least at first. This—I recently learned from an old friend—is sometimes ruefully called the “Pop drop.”
Extreme #2: “TMI.” EMS brings us a patient from a local nursing home—who is similarly unable to tell us much about their chronic medical conditions or why they’re there. They do, however, arrive with a 4-inch thick manilla envelope full of papers which seems to contain every piece of medical information ever recorded about the person. These packets are somewhat sarcastically referred to as “instruction manuals”; everything you need to know is somewhere in there, but good luck making any sense of it.
But my absolute favorite thing is when a patient (or their relative or caregiver), comes with a one-page list of their current medications. While succinctly being told the patient’s detailed medical history would be nice, a legible medication list is a pretty good proxy. If the patient is on lisinopril and furosemide, I have a good idea that they have high blood pressure and congestive heart failure (or some other reason they retain fluid enough to require a diuretic).
Sometimes, patients bring a big-ol’-bag of their medications. That’s helpful too. Not only does that tell me what medications they’re supposed to be taking, but also, to a great extent whether they are. The patient who has seven mostly full bottles of gabapentin probably isn’t taking it too often.
But the big no-no is the all-in-one pill container. Too often, I see patients who, to save space, have half a dozen various different types of pills commingling in an old unlabelled pharmacy bottle.
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Storing multiple types of pills in the same container is among the most dangerous things a person can do with their medications.
“How do you know which one is which?” I often ask
“I can tell them apart,” the answer usually is.
This is dangerous. Don’t do it. If you’re reading this now, you’re probably thinking “I’m young enough and with it enough to keep track.” And you probably are—at least, right now.
But as you get older, even mild illnesses can cause profound, short-term (i.e., totally reversible) changes in your mental status. This is called delirium; it’s caused by an acute medical problem, and it changes a person’s level of alertness dramatically and precipitously. I’ve seen patients go from doing the crossword puzzle to looking like they have profound dementia, and then back to normal, in very short order.
The problem is that patients sometimes develop just enough confusion that they lose track of things like which pill is which and yet they’re still with it enough to remember that they have to take their meds. Bad combo.
You can see how accidents happen. So please, keep your various medications separate and clearly labelled. If you’re worried about someone else you know who mixes all their meds into one bottle, tell them Dr. Jeremy says “Cut it out! You’ll get yourself killed!”
Also, if you think of it, try to keep a current list of your active medications with the doses and scheduling in your wallet or your handbag. Your future ER clinicians will appreciate it and be able to provide you with better care. If you happen to have adorable little old lady handwriting, so much the better.
Thank you. This particular blog warranted my changing from a one month trial to a yearly subscriber. I don't know how many of your readers are medical folks or, like me, people who have had way too many encounters with the medical profession necessitating learning the lingo to be able to succinctly communicate as well as understanding what I need to communicate. For me, it's not my personal medical issues but loved ones. The first major go around, my husband had Burkitt's lymphoma and we experienced a deep learning curve as we struggled through the many complications. Unfortunately, despite everyone's best efforts, the disease won.
Flash forward many years, and my current husband has also been diagnosed with lymphoma, this time DLBCL. Previous knowledge is both helpful and terrifying, and ER visits are not unusual as unknown infections, generically called neutropenic fever, rear their ugly head. We have now completed, hopefully, chemo and he insists on a winter sojourn south for a month. I simultaneously understand the need to try to have some semblance of a "normal" life and am terrified should we need an ER in place that doesn't know us.
Reading and re-reading this particular blog helps me to understand what information I need to have available in a one-page summary form, including his meds and a very short history. While not in adorable little old lady handwriting, it's given me a little piece of mind to have just the important information ready to give them -- and I'll have more of his medical information should it be requested/needed.
Last, as a caregiver, thank you for the word that I somehow previously missed learning about: Delirium. It perfectly describes what I witness. And that is somehow comforting to know it's a "thing".
Thank you writing your blog which is always informative and often very entertaining too.
Regarding your email about drugs and the elderly. I am a senior citizen ( very senior) who has no memory issues except for remembering the name of the restaurant I ate in last week. 😊
BUT here is a request to the drug industry. Often when I pick up a ( generic) prescription the manufacturer has been changed. In some cases the pill looks the same but is half the size yet it’s the same dose. ( eg Meloxicam). Sometimes it’s changed so it almost matches another pill I take.
Surely drug manufacturers could agree on generic drug sizes and colors for drugs sold in US. And some of my friends were surprised you can identify a drug by putting the description into a web site, perhaps the subject of another blog post.
Thank you for the work you do; I always look forward to your emails.