Читать книгу The Coming Healthcare Revolution: Take Control of Your Health - Sheldon Cohen M.D. - Страница 6

When a physician writes a prescription, it must be legible. If it is not, the pharmacist may have difficulty. If a patient cannot read the prescription, rewriting it is mandatory, or, at least, spelled out in writing. Sound-alike medications with similar spelling have been confused, so patients must be alert less they receive the wrong medication. There are also look-alikes, and generic medications made by different manufacturers may have a dissimilar appearance. Therefore, the moral of the story is—if there is an issue about any medication, clarify it before taking the medicine.

The busy pharmacist could misread the medication or confuse it with a medicine with a similar sounding name. The use of pharmacy technicians is common. Failure of the pharmacist to check everything the technician does has also caused prescription errors. This complicated process must be double-checked.

When a physician sees a patient, the patient should bring a list of all medications prescribed by all physicians. Some larger clinics and University Medical Centers will have a full medication list printed out for patient evaluation and confirmation. If not, then patients must come prepared either with a full medication list including vitamins, herbs and dietary supplements, or with a brown-bag with the medications. Physicians will appreciate this help and realize they are dealing with an educated and informed patient. Patients must be wary of physicians who do not think this way.

Example: A patient suffered from sleep apnea that she could not control with the recommended C-pap therapy. This is a breathing assist mechanism to prevent obstructive breathing. A dental appliance, another form of therapy, also did not help. The patient did much of her own research, and was more aware of all the physiological mechanisms of sleep apnea then most physicians. Out of desperation, she saw another doctor in consultation. And when the patient told this doctor about all the research she had done to understand her illness, the doctor stopped her and asked, “You do research on sleep apnea? The astounded patient said, “I want to know about my problem.” “That’s the doctor’s job.” he said, “That’s not for patients to do.” Her inclination was to get up, say thank you, and leave, but she did not. She asked me what I thought. I told her, at that point, you would have lost all confidence in that doctor, and I would not have blamed you if you did just as your inclination suggested, thank him, left, and found another doctor.

Patients must be certain that every physician they see in consultation is aware of any medication allergies. This is the only way to avoid receiving a medication that may cause harm. No physician can know what any patient may or may not be allergic to. Prescribing medication is a gamble, and will remain so until the era of personalized medicine (see appendix 3). At this time, a doctor does not know what any medication’s effects will be on any individual patient.

Case in point:

A patient had open-heart surgery. His doctors prescribed numerous medications. Prior to surgery his blood count was normal, and after surgery his blood count was reduced. The blood loss during surgery should have resolved and gone back to normal within weeks of the surgery, but it did not; in fact, it continued dropping to lower levels. His doctor sent him to a hematologist who, thinking of all kinds of rare diseases, recommended that he have a bone marrow biopsy. The patient decided to hold off on this procedure while he did his own personal research. He went on the internet and studied his medications, all of whom had the rare potential of causing anemia. Could this be it, he thought? Is one of the medications causing this? After understanding the possible risks of delay and getting approval from his doctor, he stopped the last medication prescribed that was for prostate symptoms and repeated his blood count after one month. Lo and behold, it was back to the pre-surgical and normal fifteen grams. He had had a rare side effect of a medication prescribed for his enlarged prostate. This information now occupies a prominent place on his medical chart. He saved himself a bone marrow biopsy, and his hematologist learned something too.

If patients are allergic to any medication, it is wise to wear a wristband identifying the offending agent.

Patients must know the following when given a prescription:

•What is the medicine and what does it do?

•How long must it be taken and at what intervals?

•What are the side effects to watch out for? If they occur what must be done?

•Are there any potential drug-food interactions that may cause a problem by enhancing or hindering the action of the medicine?

•Are there any activities to avoid while on the medication?

Pharmacists must provide information about each medicine they dispense. The patient must read this information and have questions answered before ingesting the medication.

With liquid medication, a marked syringe is more accurate than a kitchen teaspoon or tablespoon.

A hospitalized patient who receives an unfamiliar appearing medication must not take it without clarifying the issue first. This is critical in the era of generics when the same generic made by different pharmaceutical companies have a dissimilar appearance.

When hospitalized and receiving intravenous medication, the nurse knows how long the intravenous is supposed to drip before it runs out. Patients should be told as well and if not they should ask and inform the nurse if the run-out timetable is behind schedule.

If hospitalized, a nurse must check the patient’s identification wristband before dispensing medication. The failure to do this can not only lead to medication errors, but also testing errors, transfusion errors, and the discharge of infants to the wrong family.