by Stewart B. Segal, MD
Uh Huh! Two potentially dangerous words! When my children were young, we visited with my wife’s parents in Virginia. I was sitting at the kitchen table reading the newspaper. My mother-in-law placed a plate loaded with eggs and bacon in front of me which led to my asking, “What’s this?” Her reply was “You said you wanted it!” My 10 year old daughter, with the wisdom of youth, then proclaimed, “GRANDMA, when my father says, “Uh Huh” it means he’s not listening to you!” The eggs were great (her food always was), but I really didn’t need the bacon.
In my mother-in-law’s kitchen, “Uh Huh” caused no great harm. In my office, Uh Huh could be lethal. Let me explain. Medication errors are a fact of life in the world of medicine. We work hard to prevent them, yet nationally, the numbers are embarrassing! So, how does this happen? On every visit to my office, the nurse reviews your medication with you. Then I come in and review your medicine with you.
Nurse: “Mr. Patient, are you still taking 30 mg of medication A?”
Mr. Patient “Uh Huh”.
Nurse: “120 mg of medication B?”
Patient: “Uh Huh”.
This process then repeats itself over and over until the bottom of the list. The result is errors in medication doses and names. When I come in to see Mr. Patient and ask about his medications, he often sounds put out. After all, the nurse just went over them. Again, I get “Uh Huh”. Mr. Patient thinks all this is ridiculous. His doctor should know what he is taking. He says, “Don’t you keep records?
Previous articles have focused on the doctor patient partnership and education. In a true partnership, both sides take responsibility for the outcome. In an educated partnership, the conversation goes like this.
Nurse: “Mr. Patient, are your still taking 30 mg of medication A?”
Patient: “Let me check my list. Yes I am.”
Nurse: “120 mg of medication B?’
Patient: “No, I’m on 240 mg. My cardiologist increased it the last time I saw him?”
Nurse: “Are you taking medication C twice a day?”
Patient: “No, the gastroenterologist stopped that one.”
Now, I know the gastroenterologist and cardiologist are supposed to send me consult notes. Those consult notes have to be read and filed. All of that takes time. It’s a complex dance fraught with possible omissions and errors, especially if the patient is also saying “Uh Huh” in the specialist is office.
Making matters worse is the phone call to the office requesting “Please have the doctor refill my medications”. Often patients make blanket statements, giving no name, no dose, no directions, just please refill all of them. At LZFTC, we are working hard to stop all medication errors.
We have instituted electronic prescribing so that, ideally, requests come directly from the pharmacy and prescriptions go directly back to the pharmacy. We encourage all of our patients to carry an up-to-date list of all of their medications with them at all times. We encourage our patients to go on the patient portal and review their medications for accuracy. Rather than calling the office for refills and having the front desk staff transcribe the request and send it to the nurses, we encourage you to request your refill directly thorough the portal or through your pharmacy. It is of paramount importance that we, patient and doctor, listen carefully to ensure the best of care.