Do you think doctors really keep track of all medicine interaction?

In My Humble Opinion
21

I find it odd that some people equate doctors and pharmacists. They are not the same. This is not only because they have different locations where they provide service, but because one does not equal the other at all.

A physician can and will prescribe medication, this is no surprise to anyone. Their primary function is to examine, diagnose, advise and treat their patients. Often this involves medication. They know what they have prescribed you, and they might even have a good idea of what you might be taking, if you are the type that tells your doctor about every medication that you take (which IMO is never a bad idea).

One can see a dentist, a podiatrist, a gynecologist, a cardiologist, and a GP all in the same day. They don’t know what has been prescribed to you by other people unless you tell them. Of course there is some degree of communication going on, but HIPAA prevents it from being easily available between offices. Still, your GP has a pretty good idea of what you are taking, and what might interact with those meds.

Your local Registered pharmacist is a little different. Some people think that they’re just pill jockeys, filling up bottles all day long. Simply not true. They are highly trained in all of the ways that meds can be metabolized, abused, and interacted with other meds. They can’t prescribe anything, but they can and do recognize potential interactions.

The physician’s job is primarily one of diagnosis, advisement of treatment, and possibly prescription of medication. The Pharmacists job is not only that of dispensation of prescribed meds, but also that of making sure it makes sense in the grand scheme of what the patient is taking.
I’m shooting from the hip as far as some of my characterizations go, but I can sure place a bet. Take 20 uncommon, but proven, drug combinations that should be at least questioned if not refused. My money is on the Pharmacists catching the greater percentage.

22

big difference? Really? The end effect is that the stomach has been removed. It is no longer in the path. Hence the term effectively removed. I will let my surgeon know that he has been misleading me with this term. He seems adamant that I don’t need Protonix or any of the other acid-reducing drugs. Although he is the head of surgery at a fairly large hospital, perhaps I should seek to replace him. It will be disappointing, since he has seemed so competent - especially when he saved my life.

The teaching doc at the hospital, once it was pointed out to her, was at a loss as to why it was prescribed. She kept asking: were you complaining of acid-reflux?

::Shrug:: I guess I learn something new every day. I will be sure to find out why she and my surgeon and of course my GP do not feel that I need Protonix, since it is clear that the ER doc didn’t make a casual mistake.

23

If they all have the average waiting room times of the practitioners I frequent, this is not temporally possible.

24

khadaji, you still have a stomach, it still produces acid (tho in lower amounts than if it were in use for digesting food), and the stomach is a real risky site for bleeding in people on various drugs, in part because of it’s acid nature.

Your blood thinner increases the risk of such bleeding happening.

Now, whether your relative risk is high or low or medium based on your special circumstances, I have no idea. I’d advise you follow your specialist’s advice.

But the doc who put you on protonix apparently decided to reduce the risk of a possible fatal disaster, and prescribed a well-tolerated, tried and true preventive.

And I’ve been in the Ivory Tower working alongside the head of General Surgery at Johns Hopkins, I’ve been at St. Elsewhere x 10, I’ve done medicine out in the field and inside prisons, and professionals in all of those settings are capable of overlooking things, making misjudgements, mistakes, and completely missing the blindingly obvious.

And yes, USCDiver, I agree with your statement.

25

Again, no studies have proved that effect. The plural of anecdote is not data. In your case, the plural would be “grandchildren”. :wink:

26

There is a program called Epocrates available for PDAs that allows a doc to check for interactions among multiple medications. The doc has to know about meds you’re on from other docs, though.

27

Physicians also need to know about herbs and supplements the patient may be taking (this information won’t be passed on if the doc doesn’t ask or the patient isn’t up front about it due to forgetfulness or not wanting the doc to know). Here’s a partial list of herb-drug interactions.

28

I’m not on blood thinners. Well, OK. The baby aspirin that I take daily is a blood thinner, that is true. Actually, currently I am on no prescription drugs - although due to malabsorption I take a boatload of supplements. The cardiologist did not feel that he would want to prescribe any drugs unless my a-fib became chronic.

Specialist? Which doctor amongst the ones mentioned do you think is the specialist whose advice I should be following? Seriously. I have an ER doc who prescribed Protonix while I was in the hospital. None of the other docs who know me think I need to be on it. Not one *other *single doctor who has been reading my charts and history think I need to be on Protonix. Not my GP, not my surgeon, not the teaching doc that was in charge of the ER doc who was learning when she prescribed this medicine. Not the cardiologist and well, none. Just a 3rd year ER doc. A nice one. I liked her. She seemed exhausted and overworked, but I’m led to believe that this is common for doctors in that position.

Are you so absolutely locked into defending your profession that you can’t admit that a busy ER doc might have ignored my history and mistakenly prescribed a drug that **NOT ONE OTHER OF MY PHYSICIANS THINKS I SHOULD BE ON?

When asked, my surgeon - a man who specializes in “GERD and Related Topics” (taken from their web site) - said that he feels it is not necessary. My GP said he sees no reason for it, but would have bowed to the surgeon anyway. Please note this important phrase: When I asked. After leaving the ER on Thursday, I called and asked my surgeon if he thought I should be on protonix. I did this both because the teaching doc pulled the prescription after discussions with me and after reading my charts - and well, I would have followed up with him anyway. I emailed my GP. This is an instance where the docs have overlooked something. They were asked, they thought it through and they responded.

I ask again, since you recommend that I follow the specialist’s advice. Which one do you think I should be following? Since there is conflicting advice here, which of this group should I be ignoring and which should I be following? The surgeon who career is based around dealing with “GERD and Related Topics”? The 3rd year resident ER doc? Her teaching doc? My GP?

I totally agree with this statement:

This is why I think it is possible that a 3rd year resident in the ER may have overlooked my history and prescribed a medicine out of knee-jerk reflex without having thought it through. The woman who was her boss seemed to agree.

29

Sorry, I should have elaborated. By “specialists”, I meant your surgeon who operated on you, along with your cardiologist that knows your heart pretty damn well. And your family doc who’s been specializing in you all along, and following all along with your other consultants.

I also made an incorrect assumption that, due to your afib you were on warfarin. My mistake. But warfarin use is a far greater risk than aspirin for GI bleeding.

Even so, some med authorities are starting to recommend that anyone who takes aspirin might need to be on an acid blocker.

And aspirin’s effect on the stomach is not due to the physical presence of aspirin sitting in a stomach, so the fact that the aspirin never sees your stomach doesn’t mean your stomach is at no risk from aspirin.

The whole clinical question about bleeding and daily aspirin is a grey area, frankly. Personally I believe you should follow the recommendation of your surgeon and heart doc and family doc, and not some ER doc who only saw you once.

But neither would I be able to say that the ER doc was definitely ‘wrong’ for prescribing the protonix for someone who’s on daily medication shown to cause bleeding in a significant number of people.

And believe me, I’m not of the school of thought that says the med profession can do no wrong: I see waaaaay too many glaring examples of serious mistakes made by docs who were careless and/or ignorant. And overprescribing unnecessary drugs for unclear reasons. And I’m charged with the duty of correcting those errors and holding those docs to account for it also.

I just don’t see the scenario as you describe it as falling into that category, based on the info presented.

My apologies for mis-interpreting your clinical situation. That’s how a lot of errors get made in medicine, when the doc decides ahead of time that he/she knows just what is going on, and what niche to pigeonhole the patient into.

You’ve done all the right things, especially in checking things out with your trusted specialists, and acting on their advice.

30

Khadaji, I see that Qadgop has said most of the things that I would have said only better (as usual).

I only want you to know that it is physiologically possible for you to form a stomach ulcer. You probably don’t need to be on Protonix for prophylaxis, but you have to concede that having your stomach removed is a big difference from having it bypassed. You still have acid producing cells, you can still get stomach ulcers or stomach cancer, etc.

31

I feel sorry for people in the emergency department.

Imagine it is 3am,
Someone elderly comes in by ambulance:
and they haven’t got their list of medications with them
and they aren’t really coherent
and all their family knows is “they’re on some tablets for their heart, maybe it’s their lungs, but anyway, they take lots of tablets, and most of them are white”
and their GP surgery is shut so you can’t get their list
and their hospital notes are in storage
and you have to treat them anyway…

I know the big no-nos, if someone is having weird side-effecty symptoms I’ll look them up and check interactions and if I’m starting someting new I’ll check it goes with your old stuff, otherwise…not so much.

Happily I’m now working in O&G, where my typical patients is young, otherwise fit and well and takes no regular medications…yeay!

32

Speaking of which - my parents both keep a medications list, computer printed, in their wallets. Any time they have to go to the ER the nurses/doctors there are immensely grateful for the forethought this indicates.

It’s something I’d suggest all Dopers do, and (if applicable) suggest their loved ones to, too.

33

What I really really love is when patients have their whole Medical History, Surgical History, Family history, medications and allergies on a piece of paper. Not only does it help avoid mistakes in forgetful or unresponsive patients, it saves both of us time having to ask and answer those parts of the history.

34

Plus that nice note saying “Durable power of attorney for medical decisions is on file with X and designates Y” and “See medical directives related to DNR at front of chart.”

35

I doubt that they do. I also doubt that pharmacists do.

Then again, I’m a bitter, bitter cynic, and often find myself doubt that any given medical professional gives a crap. I’m at the point where I was surprised when a dentist took time to answer my questions before sticking pointy things in my mouth; I’m more used to medical types implying they just want your money, not to actually make you well*.

And now for a vaguely-relevant anecdote: I fairly recently had a tech at an optometrist’s office refuse to believe I wasn’t on any drugs. He had my ‘new patient’ form in front of him, and still asked if I was taking anything. Nope, says I. “Are you sure?” Quite, I say. Nothing beyond the occasional Sudefed for allergies and ibuprofen for various stuff. “Nothing prescribed, nothing on a daily basis?” Again, no. “I find that unlikely.” I sort of boggled and made little noises until he left the room. Note that there’s nothing on the form that would even imply I might be on regular medications, OTC or otherwise.

*Please note that I mean no offense to the medical types on this board. I fully acknowledge that I’m probably flat-out wrong about this.

36

They ask that - although saying what he did at the end was out of line - because lots of patients forget, or don’t think it’s important, or are too embarrassed to say they’re on anti-depressants/male potency drugs/whatever. Or they think that herbal supplements don’t count. I’m glad that an optometrist’s office was concentrating on this; working in ophthalmology, I’ve seen residents take histories that gloss over the non-ophthalmic meds.

One of the doctors I work for avoided a harmful drug interaction by looking up a particular non-ophthalmic pill that the patient was on, then called the patient’s doctor to confirm, and yes, it would have interacted very badly with the medication that she wanted to prescribe.

I also let a patient know that the (non-ophthalmic) med he was switched to by a different doctor was actually a combination of two drugs, and not just a different name for the drug it replaced. He had no idea - either the doctor didn’t tell him or he didn’t pay attention, and said that he hadn’t been feeling so well since the drug change. I told him to call his doctor, and I left a message with the doctor’s answering service as well.

37

I expect there’s also a problem when patients forget the names of their meds or don’t report them to all their docs/specialists. I’ve seen THAT happen before (especially from psych patients seeing other specialists and failing to report MAOIs). At that point, it’s not the doc’s fault, for sure.

The final failsafe is, of course, the pharmacist. It has happened to me – my HP prescribed something that didn’t jive with my anti-epileptic drugs. She didn’t catch the interaction, but the pharmacist did and called my GP, and they came up with a substitution that worked.

This is one of those times, too, when I really really appreciate having a network of physicians in a clinic/hospital system that share medical records electronically. Whether it’s my GP, neurologist, rheumatologist/rehab specialist clinic docs seeing me, they ALL have access to my info, in a SINGLE file. That, my friends, is awesome. If I visit the hospital in the same network (which happens to be the closest to me, as well), the same file is at hand. Talk about insanely convenient. The same applies to all the nearby walk-in Urgent Care clinics!

I’m pretty sure systems like that have had to have reduced the potential for errors like medicine interaction, duplication, or probably even over-prescription of narcotics in problem patients. :slight_smile: Me, I find it super helpful not to have to repeat myself OR to have to remember everything all the time! Woo.

38

Of course, it would help if hospital staff would pay attention when they are provided with this information. Shortly after my wife had been diagnosed with Parkinson’s she had to go to the emergency room. The full story is here, but what annoyed me is that when I talked to the hospital after they decided to admit her I gave them a full list of her medications, emphasizing her diabetes and Parkinson’s, and several days later they told me they wanted to keep her a few extra days because she was having “tremors” - and it turned out that they hadn’t been giving her any of her Parkinson’s medication. :rolleyes:

39

I can definitely understand the appeal of this, but doesn’t it make you a little bit uncomfortable, privacy-wise? I personally consider the patient-controlled ‘need-to-know’ method better. If there’s no reason for Doctor B to know what Doctor A is treating me for, why should they have access to that info?

40

Because perhaps they DO have a good reason? Perhaps Dr. A’s treatment might interfer with something Dr. B wants to try. What then?