Medication Safety: “But it’s only aspirin!”
January / February 2009
Medication Safety
“But it’s only aspirin!”
I recently conducted a medication history for a patient who was seen in our clinic for rectal bleeding, weakness, and blurred vision. Mrs. J. is a pleasant woman in her mid-80s who was visiting to our cardiology practice for the first time. Being a conscientious patient, she brought along her medications: levothroid, Lipitor®, lisinopril with hydrochlorothiazide, a Fosamax® card, and a bag of sertraline tablets.
Like many patients, Mrs. J. knew well the prescriptions she was taking. She mentioned recent incidents that caused her to contact her physician, along with office visits, and why she received new prescriptions. When I asked, “Are you taking any other medicine?” She replied emphatically, “No!”
I asked Mrs. J. what she takes for a headache. She replied, “Oh, I just take some Ecotrin®, and that usually takes care of it.” When I asked how often she does that, she answered, “several times each week,” adding that she often takes Ecotrin again before bed because it helps her neck and leg pain.
“Hmm… Mrs. J., does your stomach ever bother you?”
“Oh, there are times when I just can’t stand it, so I take my Alka-Seltzer PlusÆ. That seems to help. And then I take two Alka-Seltzer Plus tablets every night before I go to bed. I’ve been doing that for years. I really think it helps and has something in it that helps me sleep, too.” Dare I mention Mrs. J. also has a glass of wine and some Scotch every night with dinner?
I tallied how much aspirin Mrs. J. is taking. I asked if she realized both Ecotrin and Alka-Seltzer Plus are aspirin products and commented that she regularly takes more than enough aspirin to contribute to her recent bleeding episode. Her response was, “Why would I worry about it; it’s only aspirin!”
This brings me to my main point: Yes, it is only aspirin, a product available in every supermarket, convenience store, pharmacy, gas station, health food store, or tavern. It (and many other medications) can be bought by anyone with no questions asked. Moreover, it’s contained in a variety of OTC products (like Alka-Seltzer Plus and Ecotrin), so patients may not realize how much they are consuming.
The worst cases arise when a patient says, “But it’s only aspirin!” Only aspirin? In other words, “This can’t be anything worth mentioning, so why do you ask? Do I need to tell you what I buy at the grocery store? Why are you so nosey? Why are you wasting my time?”
Patient education is critical to our success as practitioners. We must take the time to talk with patients about the significance of OTC medications, especially when they are taking prescription medications concurrently. While at every office visit we routinely question patients about non-prescription medications , if the patient doesn’t equate a grocery store purchase with “medications,” there is a good chance you won’t even know the patient is taking it.
In the office environment, who takes your patients’ medication histories? Do they understand why it’s important to receive an accurate picture of all medications each patient is consuming? Have they been properly trained? Do they recognize the importance of knowing all the OTC and herbal supplements? It is one thing to get a list of medications patients say they are taking, but it’s another to inquire further and accurately document all of the medications theyare taking.
Our practice sees patients spanning a wide variety of ages and socio-economic backgrounds. We can’t assume they all fully understand the ramifications of OTC medications and supplements. Under the right conditions, these products can be as powerful as prescription drugs for which we use technology to monitor use at the highest level possible. While we are most likely doing a good job on the prescription side, our patients leave our controlled practice environment to consume OTC products and herbals often without regard to specific interactions, or worse yet, without even a general understanding that they may potentially be harmful. It is our responsibility to assure they leave our environment with this awareness.
Larry Pawola is associate professor and associate dean on the faculty in the College of Applied Health Sciences at the University of Illinois at Chicago. He also is president of his own healthcare information technology and clinical services consulting firm, Lincolnshire Consulting Associates LLC. As a respected industry consultant for more than 25 years, Pawola has worked with a variety of ambulatory clinics, community hospitals, and academic medical centers. His work has focused on assessing clinical systems needs, operational improvements, strategic planning, and education. He has also consulted with healthcare companies for the strategic positioning of their technology products. Pawola is a member of the Editorial Advisory Board for Patient Safety & Quality Healthcare. He may be contacted at lpawola@uic.edu.