Is Your Doctor Reconciling your Medications?

The Institute of Medicine’s (IOM) seminal study of preventable medical errors estimated as many as 98,000 people die every year at a cost of $29 billion.  Everyone who is taking medications should be concerned about the adverse potential of medication side effects, as well as problems due to drug interactions.  The Joint Commision, recognizing the risks of medication use, has begun to place  major emphasis in its surveys of hospitals on a process called "medication reconciliation". 

Medication reconciliation involves a detailed review of current medications and doses, including assurances that the patient is taking the medications and doses as listed in the record.  This process is especially important during transitions of care such as at the beginning of a hospital admission, transfer of a patient from one unit to another, from surgery to the medical floor, or upon discharge from the hospital.  It is also important, during routine visits to the doctor and, whenever a new medication is listed, determination made that no adverse interactions are likely with the new combination.

I strive to reconcile medications at every patient's visit with me.  This may occur during annual preventive care visits or during follow up visits with patients who have chronic disease states such as diabetes or hypertension.  The process also needs to include over the counter medications and supplements, in addition to any prescriptions provided by another physician.  I am continually amazed that, in virtually every visit, a patient's medication list requires at least one or more modifications.  I am also amazed that, whenever I see someone else's patient, the list is frequently woefully inaccurate and, in many instances, appears to have never been reconciled.

What, then, is the point of this article?  It is to make patients more aware of the importance of medication reconciliation and challenge you to become an active partner in the process with your primary care physician.  How can you do this?  Many clinics print out a medication list for review when you check in to the clinic.  If this is not happening, I suggest requesting it from your team.  Additionally, it will be helpful for you to bring a list of the medications and doses that you are currently taking, as this will provide a helpful and accurate tool for the nurse or physician to use to "reconcile" your medication list. 

A brief list of the various actions that may result from this process will illustrate the importance of medication reconciliation:

1. Elimination of drugs that the medical teams think you are taking, but aren't.
2. Identification of, and deletion of, medications that could be causing a dangerous drug interaction.
3. Elimination of drugs to which you may be allergic.
4. Drug by drug review of potential side effects you may be experiencing.
5. Addition of drugs provided by another doctor that your primary physician did not know you were taking.

You can become a more active participant in your own health care by assisting, or initiating, the process of medication reconciliation and making sure it happens with every visit to your doctor. 

Your comments or opinions are always welcome.