When the patient with the symptoms of acute stroke is being evaluated in the Hospital, he or she is shown a picture from NIH (National Institute of Health) stroke scale to assess the patient’s judgment (Click on image above to see the picture) . As I am staring at this picture, while sitting in ER, I realized – as far as I am concerned, there is nothing wrong with this image. That exactly how my house looks when I am in charge of watching kids. This made me think that often we fail to consider the patient’s own perspective when administering treatment and medications. We are often concerned about the side effects and mechanism of action of any given medicine. It is that human factor not the side effect of the medications that often brings the patient back to the hospital. There are several ‘risk factors’ or what I call them ‘dysfunction factors’ that put the patient at the higher risk of side effects, complications and hospital readmission.
Here they are:

1.The patient has no idea what medications he is taking and why. Often I hear: “It’s all in my records” when I ask about medications. I have seen patients taking their diuretics and blood pressure meds, even though, they were already dehydrated with diarrhea or viral illness. Next thing you know that patient is in ER with the blood pressure in the 50’s.

2.There are more then twenty medications on the patient’s list. It would be a full time job just to keep track of those meds. Some medications are being taken two or three times a day which adds even more confusion.

3.The patient is ‘allergic’ to more then ten medications. Usually, it’s not a true allergy, but rather some side effects that the patient has experienced. It makes it difficult to treat an infection, for example, if the patient is ‘allergic’ to most of the antibiotics.

4.The patient is taking the same medication twice under different name. This happens rarely now due to electronic pharmacy records.

5.The patient is requesting a specific medication for pain. I often hear: “Only IV Dilaudid works for my pain”. This usually raises a red flag.

6.The patient is allergic to steroids (Prednisone). Prednisone is actually being used to treat allergy. Patients might have side effects to this medicine, but allergies are unlikely.

These are just a few things I came across in my practice. The list by no means is complete. Feel free to add things that I missed.