What drugs are you on?
Medications are a key part of taking a patient history.
While I never say it the way the title has it, here’s some tips and tricks I’ve learned to get all the facts.
I typically start with:
“What medications are you currently taking?”
Meds often give you a list of the patient’s diseases, but often meds become so routine that patients omit one or two when you ask. For example, synthroid, aspirin, and statins are often left off the list because a patient has been taking them for as long as they can remember. Patients are more apt to report something they started taking a few months ago, not the med they’ve been taking for 10 years.
It’s also good to fish for any drugs they recently stopped taking or ran out of refills.
So this is often just a good start, but the next three questions will help make sure you have all the information.
“What pills do you put in your mouth every day?”
Restating it this way often shakes out one or two loose meds. Also go beyond pills and prescriptions: herbals, over the counter, vitamins, supplements.
Just having the list is not enough. For every med on that list, you need two more things: why are they taking the pill, are they actually taking the pill.
“Why are you taking that?”
Meds have off-label uses or can be used to treat multiple disorders. Don’t just assume that because the patient is on synthroid that they have hypothyroidism – they could have had a thyroid removed due to cancer.
“How often do you miss a dose?”
So many patients are ill simply because they’re skipping doses. Other variants: Are you actually taking it? How many doses have you missed in the last month? A common scenario is for a hypertensive patient on medication to show up with high blood pressure because they forgot to take their meds that morning or ran out a week ago.
Often patients simply forget, so walk them through some strategies to remember: pill boxes, rituals (at breakfast, when setting alarm at night, in car while commuting), or multiple pill caches for when you forgot and you’ve already left the house.
Any tips you use?
For some levity, watch how to get a thorough history.