With all the medical advances we’ve seen in recent years, it’s easy to forget sometimes that ultimately we are responsible for our own health, and that our healthcare providers are there to guide us, but may not know our circumstances as well as we do.
So as we observe Canadian Patient Safety Week, we are reminded by the Canadian Patient Safety Institute to be strong self-advocates and to be active participants in the decision-making process around our care. This year, the theme of the week is “Ask, Listen, Talk”, focusing on the safety of prescription medications.
Many of us take a passive role in our care, and will dutifully take any medications our doctors recommend. But doctors aren’t perfect, and they may not always have all the information they need to make the best decisions about our care. Your Express Scripts Canada Pharmacist is a great resource, who may be able to advocate on your behalf based on a more comprehensive view of your full prescription profile, but ultimately, you as the patient are the only one with the complete picture of your health.
With that in mind, there are five key questions that you should ask your doctor or pharmacist about your prescriptions, especially when there is a potential change in medications, or if you have a number of prescriptions from different doctors. Express Scripts Canada pharmacist Alan Strashok explains why they are so important:
1. If medications have been added, stopped or changed, why?
If your doctor doesn’t have your complete health picture in mind, he could be prescribing to address a condition that is already being addressed by another physician. For instance, you may already be taking something for anxiety, prescribed by a specialist, and your family doctor could prescribe another drug for the same problem. Unless they prescribe the exact same drug, you may not realize that it’s a duplication. Always ask, why are you prescribing this?
Likewise, if your doctor chooses to discontinue a particular medication, or switch you to a different drug for the same condition, make sure you understand why. Always ask why.
2. What medications do I need to keep taking on an ongoing basis, and why?
Some medications are meant to cure you, and some are meant to simply treat symptoms so that you can live a normal life. We don’t have a cure for diabetes, for instance. There are medications that allow you to live with diabetes, but most people have to continue taking them as long as they live. These are typically referred to as maintenance medications. If your doctor prescribes something for diabetes, high blood pressure, depression, anxiety or high cholesterol, usually they expect you to stay on the medication on an ongoing basis. In most cases, going off a maintenance medication or waiting too long to pick up a refill can have serious health implications.
There are also some maintenance medications, such as antidepressants and some acne medications, that are intended for a finite period of time until the condition improves a certain amount. If you’re not sure how long you are supposed to take a medication, you need to ask. Your pharmacist is your best resource for questions such as these and is always available for consultations.
3. How do I take my medications, and for how long?
If a medication has to be refrigerated, if you have to take it with meals, far from meals etc., there will be instructions on the bottle, but if you don’t understand the instructions, don’t be afraid to ask your doctor or pharmacist. Understanding why is also important. Some medications can upset your stomach, so pharmacists recommend you take them with meals. However, in other cases, the actual effectiveness of the drug can be impacted depending on whether you take it with food or not. For some medications, certain foods such as grapefruit or dairy products may greatly impact the effectiveness and even safety of the medication. Some medications may react badly with other medications, or with certain vitamin and mineral supplements.
The details are critical to getting the most out of your medications, so don’t just think you understand the instructions. Make sure you understand. Every time you are prescribed a medication that is new to you, your pharmacist should go over critical instructions with you, and encourage you to ask questions to ensure that you understand and feel confident.
In terms of how long, again, some medications are meant to be taken ongoing, and others aren’t. For some medications, your doctor may give you a refill, but advise you to only fill it if you need to. Even for some medications which are intended to be taken indefinitely, the doctor may not give you a refill on your prescription at first, because he/she may want to run blood tests to make sure the medication is working and that there are no severe side effects. If you’re not clear, ask: Do I have to refill the prescription? Do I have to finish the bottle if I feel better? Asking the question is never wrong.”
4. Monitor? How do I know if my medication is working, and what are the side effects to watch for?
Every medication has a desired effect, and usually some known side effects. Your physician will use her/his best judgment to weigh the potential benefits to you in treating your medical condition as compared to the potential risks or side effects. A doctor should know these quite well, but may also assume you know. At the risk of sounding like a broken record, if you don’t know, or if the doctor hasn’t explained, you should ask. Will you notice the medication taking effect right away, will it take days, weeks? What are the most common side effects? What are the most dangerous potential side effects? These questions could save your life.
Your pharmacist should let you know the most severe and dire potential side effects and their warning signs, even if the chances of those side effects are miniscule. By being informed, you can let your doctor know right away if you see signs. Some medications, for example, can damage your liver. Your pharmacist might tell you to watch out for dark or tea coloured urine or yellowing of the whites of your eyes. If you see these signs of severe side effects, you can discontinue the medication and seek help. But even if the side effects are mild, it will ease your mind to know, OK, this can cause hair loss, or drowsiness etc. If the pharmacist leaves out any details, you can ask. Is the hair loss temporary? Can I drive if the medication makes me drowsy? Just ask.
5. Do I need any tests and when do I book my next follow-up visit?
Medications are prescribed based on how they work in MOST people. This is very important. The effect of a medication is seldom exactly the same in everyone. Usually, if a doctor prescribes something, they will ask you to book another appointment so they can ensure that the medication is having the desired effect. The doctor will, in some cases, order blood tests to measure positive effects and negative effects. For cholesterol drugs called statins, for instance, your doctor should order blood tests to confirm whether your cholesterol and triglyceride levels are improving, and whether the medication is affecting your liver.
In other cases, they may ask you to call and book an appointment only if you don’t feel better. If you don’t know what the next step is in your treatment, ask. If you don’t feel comfortable continuing to take a medication without seeing your doctor regularly, book a follow up. If tests are recommended, take this seriously. They are meant to keep you safe. Also, don’t ever stop taking a maintenance medication suddenly on your own without the advice of your physician or pharmacist.
Ultimately, your healthcare providers have your best interests at heart, and together, your doctors and pharmacists can help you make the best decisions regarding your care, but they don’t know everything about you. By asking a few questions, and making sure you understand what medications you are taking and why, you will reduce your risk of negative drug interactions and maximize the chances for great health outcomes!
We encourage you to visit the Canadian Patient Safety Week site, to learn more about patient safety issues, hear patient stories, and educate yourself on how we can all be healthier and safer.