Don't you know what you've prescribed?

January 27, 2016 6:06 AM

Why would my PCP want me to bring my bottles of meds to the appointment?

I have a followup appointment this Friday with my PCP. As usual, I got a call from them this morning reminding me of the appointment. Then, the woman who called told me to remember to bring with me all of my medications in their bottles. Wha?

I currently take an anti-depressant, a beta-blocker, and omeprazole, all of which are refilled monthly. I also have a bottle of pain killers that my doc wrote me a no-refill script for about a year ago, to use on an as-needed basis, due to pain associated with my back surgeries. I've (thankfully) barely touched it over the past year.

I've never been asked this before (and I've been seeing this doc for over 30 years.) What purpose does it serve for me to bring in my few bottles of meds?

posted by Thorzdad to Health & Fitness (20 answers total)

You know what meds you take, but the average person is a notoriously unreliable narrator. A lot of people have prescriptions from their primary doctor plus other prescriptions from specialists, so everything might not be logged in their file at any one doctor. Even if someone knows every medication they take (and honestly, I think a lot of people don't), they might not know the dosage or when they'd be due for another refill.

Since you've been seeing this doctor for such a long time, it's possible that this is a new policy or that it's not strictly necessary for an established patient but the woman on the phone told you anyway.
posted by kate blank at 6:11 AM on January 27, 2016 [18 favorites]

My doctor has started doing the same thing. I'm not sure if it's a new law / FDA reg, or something being pushed by insurance companies, or what, but it's not just you. My doctor seemed to think the new rule would be fairly short lived given the inconvenience, but maybe that was just his wishful thinking.
posted by ryanrs at 6:14 AM on January 27, 2016 [2 favorites]

Yeah - my guess is that they want to see both the names of the drugs and the exact dosages.
posted by ryanshepard at 6:14 AM on January 27, 2016 [3 favorites]

Instead of bringing the bottles, I snapped a picture of them to show my Dr.'s office. It seemed to mollify them.
posted by AugustWest at 6:26 AM on January 27, 2016 [1 favorite]

You'd be really surprised at how few people know their own medications, especially dosages. They're just playing it safe. You're probably in a minority of patients who has a good handle on it.
posted by something something at 6:29 AM on January 27, 2016 [10 favorites]

Best answer: Your doctor also wants to know what other doctors are prescribing for you.

There are lots of drugs with interactions and not every doctor catches them when prescribing, even if you have listed all your meds correctly.

Your doctor isn't just covering his ass, he's considering an increasingly complicated number of prescribers.
posted by bilabial at 6:43 AM on January 27, 2016 [11 favorites]

Probably because I'm the idiot who sits there going, "I take Xfludex." And then the nurse goes, "Do you mean Xfludium?" And then I'm flummoxed. And then she says what dosage, and I go "It's blue?" Sorry on behalf of all of us that all of you who know it all back and forth have to go through this rigamarole.
posted by BlahLaLa at 6:44 AM on January 27, 2016 [38 favorites]

Best answer: The big deal in treatment is "compliance." This is a gnarly and kinda gross term for "people taking drugs as prescribed," but it's what we have. One way to work on patient compliance is pill-checking and actually investigating non-persistence in treatment. You can't bring in prescriptions that you haven't refilled, for instance. :)

These ideas are why HIV care practices at nonprofits promote methods by which clients come in every day for lunch, or for special programs, or for just hanging out. The line of thought there is if you get someone there every day you can also be like "Oh hey, tell me about which pills you took today and when." Or you can physically look: for instance, they talk about doing physical pill counts here. (NB, I am not anything like a doctor but I am a former HIV caseworker, and one of our biggest goals with program design was engineering better treatment compliance.)

It's nice to have people like you who are on antidepressants or similar categories of drugs get checked in on as well. Mental health treatment has a pretty low rate of compliance. It's easy to pop an omeprazole every morning—I almost never miss mine. But it's far more loaded to treat more culturally "serious" issues, and people take themselves off treatment for things like depression or more serious issues all the time without consulting a doctor.

There's a ton of literature on this topic online (lots on Google Scholar) and it's fascinating if a little dry and sometimes rather saddening about how we all behave as funny humans.
posted by RJ Reynolds at 6:44 AM on January 27, 2016 [8 favorites]

To echo others: it's not because the doctor doesn't know what they've prescribed; it's because this is the most reliable way to see what you're actually taking, regardless of who prescribed it.
posted by ocherdraco at 6:50 AM on January 27, 2016

Best answer: Medicine does a pretty crummy job at coordinating care and communication amongst practitioners. Some electronic health record systems can track medications amongst prescribers but most cannot. I cannot even tell you how often in a day it happens that I ask my patients what they are taking and they get it wrong. It happens frequently that they will rattle off "all" their meds and then I can see through EMR there are others they've been prescribed. What about this metoprolol? Oops, yeah that too. What about this Norco? Oh yeah, I rarely take that. What about this cialis? Oh yeah, that too. And that's when I have access to what they've been dispensed through a reporting pharmacy! But more often I literally have no idea what someone has been prescribed by someone else unless the patient can accurately tell me (and let's be honest, prescriptive meds are not known to have the most easy to remember names). It is a never-ending source of frustration and it makes my job a whole heck of a lot harder.

I used to have my patients bring in all their meds when I worked in internal medicine at every single one of their visits. It wasn't a reflection of how I felt about their character just that prescription errors and medication interactions are very common and can have potentially serious implications. I would assume your PCP is just being thorough. I wouldn't sweat it.
posted by teamnap at 6:58 AM on January 27, 2016 [10 favorites]

RJ Reynolds is exactly right. In addition to confirming all the meds that you are on, by looking at the bottles themselves they can also look at the dates prescriptions were filled and see how many pills are remaining to determine if you are indeed taking the meds as prescribed (and not taking extra or forgetting to take them).
posted by Rock Steady at 7:03 AM on January 27, 2016

Yeah, just adding to the chorus that this is normal. My work intersects with a health care system where the vast majority of patients get all their prescriptions filled by the same place and are in the same records system and we still ask people to do this sometimes because honestly med compliance is terrible and the records aren't always reliable. Pill counts are sometimes the best option for figuring out that people are actually taking what you think they are.

Don't take it personally.

(I am also a howling hypocrite because I complain endlessly about how patients are bad historians but the last time I went to a doctor I totally forgot to mention a whole chunk of relevant family medical history and a medication I had been on until my SO reminded me.)
posted by Wretch729 at 7:11 AM on January 27, 2016 [1 favorite]

My mother is on a lot of meds. Before I encouraged her to keep a very careful list that is updated her doctor would have her do the same thing. Hell her pharmacist did it once when she started a new med for her kidneys as she is on a lot of stuff & they wanted to double check that nothing was contraindicated and that at 74 she had her shit together enough to be taking her stuff as she should.

A lot of people are too casual about their meds & keeping track of them, I imagine it's just standard procedure to make sure & no direct commentary on you or your prescription meds, it's a safety net to catch those that can't/don't/won't.
posted by wwax at 7:37 AM on January 27, 2016

That's just a thing they say now, to everyone. Bring a list with strengths and dosages (and/or pictures of the bottles) and you should be fine. I am always told to bring bottles, I never bring bottles.
posted by jessamyn at 7:52 AM on January 27, 2016

This is almost certainly just to make sure they know what you're taking. A lot of people, especially elderly people, are on a lot of medications from different providers and even when I try to confirm what they're taking from my list it rarely goes smoothly ("so, you're on amlodipine, for your blood pressure, is that right?" "Is that the white one?". Or "My cardiologist started me on something for my heart. It's green.") Furthermore performing "medication reconciliation" is now a requirement. My practice has started giving people prizes when they bring in their medications. I've also had people bring in giant bags of medications and realized that they were taking multiple duplicated prescriptions because they were using more than one pharmacy or had gotten refills before they had finished the first prescriptions.
posted by The Elusive Architeuthis at 7:56 AM on January 27, 2016

I'm a home health nurse. When I go to someone's home to admit them to our services, I have a list of their prescribed medications (most patients enter home care after being hospitalized, and the med list is part of their discharge instructions). I'm required to reconcile the list against the medications that are actually in the home. Do they have everything on the list? If not, how will they get it? What meds do they have in the home that aren't on the list? Do they understand their medication instructions, including any changes that were made while hospitalized? The list says 40mg of Lasix daily, but these are 20mg pills -- do they understand they need to take 2? They say they take Advil, which is over the counter, for pain, and saw palmetto "for my prostrate" -- is their physician aware of this? What's up with this "extra" bottle of antibiotics dated 3 months ago with 4 pills left in it? There's a handwritten, undated list of medications in the cupboard with the pills that doesn't match the list from their discharge instructions ...

There are a LOT of things that can go wrong with medications.
posted by shiny blue object at 8:00 AM on January 27, 2016 [2 favorites]

To address the implied question of "why now?":

The term of art for this is "medication reconciliation" or "meds rec" for short, and it's a core measure in Meaningful Use Stage 2. The denominator for the measure is technically limited to new patients, but it's probably easier for the practice to change their standard processes so that they do meds rec on everyone.
posted by slenderloris at 8:33 AM on January 27, 2016 [2 favorites]

I was asked to do this with narcotics to insure I was taking them as directed. Turned out I wasn't. Which was no big deal, since I was taking less and not hoarding them to take for fun. But even then I got a lecture about how I was supposed to take them as directed. I decided to discontinue their use instead (I didn't see a reason to take them as a maintenance drug or when I wasn't in pain).
posted by cjorgensen at 9:21 AM on January 27, 2016

Yeah, totally normal. And not just in the US, they do the same thing here in Canada as well. A person could have prescriptions from multiple specialists in addition to their gp and it's very easy to forget about one when put on the spot.
posted by rodlymight at 9:21 AM on January 27, 2016

Every time I go in now, they give me a sheet with, like, everything I have ever been prescribed. The nurse blandly asks if these are my medications, and I reply that no, several were for one-off things and of course I don't take them any more now that I got better. Presumably they update their records, but the same list appears every time!

My guess this is the same function as the request that you got: a reality check and to verify that their notes match your meds.
posted by wenestvedt at 12:54 PM on January 27, 2016