Not leopard skins: Pillboxes can prevent medicine flubs

Amy Winehouse, Heath Ledger, Janis Joplin, Jimi Hendrix– so many people have overdosed on drugs. In The Rose, Bette Midler’s character swallows pills like a hypoglycemic child in an M&M store, which leads to her death. Not that I would ever want to overdose on something, but if I did, it would be sushi, not drugs.

Do patients take their medicines like celebrities overdose?

As an internal medicine doctor, one of my main roles is to manage pills. I should wear a pillbox hat like Jackie O.

Knowing if my patients are taking their medicines correctly can be as challenging as auditing Enron’s books. Although I give all my patients a typed-out instruction sheet that includes a table of their medicines, patients can be pretty clueless about what they're putting into their bodies.

“Ms. Doe, are you taking your new blood pressure medicine I prescribed at your last visit?”

“What new medicine?”

“The one I have written in bold and highlighted twice on your info sheet.”

Sigh.

Welcome to my world. This example is why I ask my patients to bring all their medicines with them each visit– so I can actually see what they're taking. Nonetheless, when patients are taking several medicines, they usually forget to bring a few bottles.

It also drives me crazy when consulting doctors don’t communicate with the Primary Care Physician. You can’t always rely on patients to tell other doctors what they’re taking. How many patients can remember or even pronounce “Lisinopril-Hydrochlorothiazide 20/25mg 1 po QD?”

In Archives of Internal Medicine 2011, a study showed nothing really new or surprising: older patients often don’t take their medicines correctly despite written instructions. Perhaps it's due to poor vision, poor memory, or decreased reading skills. Often it's because of the complexities of taking some medicines on an empty stomach, others on full stomach, others just before a meal, others right at bedtime, some not within 30 minutes of other pills, and so on.

One-third of people in this study didn’t take two different medicines at the same time despite identical instructions. When instructed to take a medicine with food, only half did it right. When I tell some patients to take metformin (for diabetes) with food so they don’t get an upset stomach, I still have some folks take it on an empty stomach. When I have them read out loud their instruction sheet (just to make sure their reading is okay), their response is, “Oh, how did I do that? No wonder I feel like throwing up after I take that pill.”

Pillboxes can help patients correctly schedule their meds. Pillboxes remind them to take a pill as well as to remember if they already took the pill. Yes, it’s easy to forget taking a pill.

“Did I take my blood pressure medicine? Umm, I can't remember; I’ll take it now just in case.” Overdosing occurs this way. Fainting from low blood pressure– or even kidney failure– can occur from accidentally taking too much medicine.

Thank goodness for home health nurses who have straightened out a lot of medicine problems for my more vulnerable patients— although sometimes family members accidentally “sabotage” the nurses’ work.

“I think mom should take her medicine this way, not that way; so I changed it…”

I joke that age is not the number of years you've been alive, but the number of beauty products and medicines in your bathroom. Let’s just hope the beauty products far outweigh the medicines.
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Dr. Hook cracks a joke or two, but he’s a respected physician with an interesting website, drjohnhong.com. Email him with your questions!