Had she changed her diet? No. Been exposed to any new plants or pets? No, again. Changed the cleaning products or detergents she was using? No. Bought some new items of furniture or a new carpet? No and no. Caught a cold? No. Recently changed her medication regimen? No, she didn't think so.
Here's what she knew had changed: Earlier in the year, the pulmonologist she had seen for years died. My colleague wasn't having problems with her asthma at the time, so she didn't seek out another doctor until she needed a new prescription for her inhaler. At their first meeting, she went over her detailed history with him and, at the end of the appointment, asked for the refill. Looking at the inhaler she held in her hand, he scribbled on his pad and handed her the slip. Over the next couple of weeks, her breathing became more shallow. She was wheezing and her chest felt tight. She was using her inhaler more often.
The prescription inhaler she had used successfully for so many years, she eventually discovered, comes in two strengths. In his haste, the new physician had written a prescription for the lower dose. It was a simple mistake and one that is not uncommon. Each year, nearly 4 billion prescriptions are filled, and more than 50 million medication errors occur. The mistakes result in more than 1.5 million injuries annually. According to the Institute of Medicine of the National Academies, more than 7,000 fatalities a year are attributed to prescription mistakes.
We'll never be able to eliminate all errors from the process, but we can take precautions. To prevent misunderstandings that may arise from doctors' famously illegible handwriting, for example, my colleagues at the Martha Stewart Center for Living at Mount Sinai Medical Center print their prescriptions from a computer.
It's also important that patients get the information they'll need about a medication before leaving the doctor's office. It sounds obvious to patients and doctors alike, yet it doesn't always happen. A 2006 study at the University of California-Los Angeles and the University of California Davis Medical Center analyzed conversations between doctors and patients. Sixty-six percent of the time doctors prescribed a medication but said nothing about how long the patient should take it. In 45 percent of cases, doctors didn't say what dosage to take, and in 42 percent of the exchanges, they failed to mention the timing or frequency of doses. Physicians mentioned adverse effects only 35 percent of the time and failed to explain what the medication was for in 13 percent of the conversations.
I'll be honest. There have been times when I've been less than thorough in my explanations. On these occasions, my patients called my office afterward, as they should have. If a physician doesn't initially provide answers, here are questions you might ask.
What medication is being prescribed, and what is it for?
What is the dosage?
How many times a day should I take the medication, and do I need to take more than one pill at a time?
How long will I need to take this medication? (Days? Weeks? Indefinitely? Until it's used up? Until the symptoms go away?)
What should I do if I forget a dose?
What time of day should I take it?
Should I take the medication with food or on an empty stomach?
What are the possible side effects, and what should I do if they occur?
Is it safe to take with other medications, supplements, or alcohol?
Deciphering what a doctor writes on a prescription slip offers another set of checks and balances.
When you pick up your prescription, take a minute to make certain the label matches what you thought you were getting. If you notice a discrepancy, tell the pharmacist. If you're familiar with the prescription you're picking up, such as a refill, you might notice changes. The shape and color of some pills, as well as the engravings that appear on some tablets, can change from one refill to the next, especially if the pills are generic. But if you have any doubts, ask the pharmacist.
As soon as my colleague's physician realized his mistake, he wrote her the correct prescription, and her asthma status returned to baseline. She was happy the problem was resolved and continues to see him. Live and learn. Because she has been gracious enough to let me share her story in the pages of Martha Stewart Living, the rest of us can learn a valuable lesson, too.
q.d. = quaque die = every day
b.i.d. = bis in die = twice a day
t.i.d. = ter in die = three times a day
q.i.d. = quater in die = four times a day
a.c. = ante cibum = before meals
p.c. = post cibum = after meals
q.h.s. = quaque hora somni = at bedtime
q.2.h. = quaque 2 hora = every two hours
p.r.n. = pro re nata = as needed
ut dict. = ut dictum = as directed
p.o. = per os = by mouth
sig. = signetur = let it be labeled
gtt. = gutta = drop
o.d. = oculus dexter = right eye
o.s. = oculus sinister = left eye
i = one, ii = two, iii = three
tabs. = tablets
caps. = capsules
d.a.w. = dispense as written
disp. = dispense
mg = milligrams
mcg = micrograms
"Rx: acetaminophen 650 mg sig.: i p.o. q.4.h. p.r.n. disp.: 30" means "Prescription: 650 milligrams acetaminophen. Take 1 tablet by mouth every 4 hours or as needed. Dispense 30 pills."
Text by Brent Ridge, M.D.