Medicine jeopardy: knowing the facts

Helen (not her real name) was found to be taking 37 prescription medications. That’s right, 37. Her situation was reported in a recent issue of the Tufts University Health and Nutrition Newsletter. Helen had a primary-care physician, a rheumatologist, a cardiologist and a psychiatrist, all of whom were prescribing medications for her. Not one of her doctors was aware what the other was providing.

There’s more. One day, Helen began experiencing significant nausea and she went to an emergency room, where they gave her yet another medication. She’s now at 38 medications.

Enter a perceptive clinician who looked at Helen’s situation and the medications she was taking and said, "We need to seriously reassess this — now." The clinician found that digoxin, a drug prescribed by Helen’s cardiologist, was causing the nausea. He went further, using a list called the "Beer’s Criteria for Potentially Inappropriate Medication Use with Older Adults" and cut the drugs she was taking almost in half.

Let’s get personal. Recently, at the encouragement of my husband, I went to an urgent-care doctor to get a better understanding of my persistent cough (it was keeping me awake at night, him too). The diagnosis: "unsure — so many viruses, hard to identify."

I left that physician’s office with three prescriptions: a new fast-track antibiotic, a narcotic-based cough syrup and some gelatinous capsules I was supposed to take if the cough medicine didn’t do the trick.

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I’m not proud of how I handled this. I did not question the quantity of prescriptions or the fact that I was given a narcotic cough syrup laced with codeine when I had a history of being allergic to codeine.

It was late on a Friday night and I just wanted to get home — wanted to be able to say to those concerned about my cough that I had, indeed, "done something" about it. The cough disappeared (aged out, I think, although I took the antibiotic). The duet of other medications still sits on our kitchen counter, barely touched, $40 worth of cough suppressant. As I said, I’m not proud of this moment.

I talk about medication jeopardy all the time and yet on a hot summer evening when I was feeling unwell, I demonstrated none of the question-asking vigilance that I preach about — zilch.

I never pulled out the wrinkled copy of the Beer’s list I carry in my purse and checked to see it any of these medications were on it. I didn’t ask questions, especially the most basic one: "If I made some lifestyle changes (more rest, chicken soup, vitamin C), would I need to take these prescription medications at all?"

When it comes to medication jeopardy, the Beer’s list (get a copy at the Bartel’s Library at the Smullin Center at Rogue Valley Medical Center) is a useful reference tool. But it doesn’t help reduce the risk unless it’s used. Sort of like: "Questions that don’t get asked don’t get answered."

Sharon Johnson is an assistant professor in family and community development at OSU Extension and a member of the Senior Advisory Council. Reach her at s.johnson@oregonstate.edu.