What’s in your medicine bottle? Your prescription may not be what the doctor ordered!

Just last week, two patients asked me how they could tell if they were getting the right drug. Their pharmacy benefits plan had mailed them their refills, but the drugs looked totally different. In the case of my migraine patient, Leslie, 80 milligrams of Inderal® was now a blue capsule whereas in the past it had always been a yellow tablet. "How do I know if I’m getting the right thing?" she asked.

It's a good question and consumers have a right to be concerned. Years ago when my brother developed bronchitis, he was given a script for the antibiotic Vibrax® (a drug no longer prescribed) by our family physician. By the time he had finished the bottle, his cough was worse and he was even more run down, so the doctor's office phoned in another course of treatment. It wasn't until my brother picked up the pills from the pharmacy and saw that they looked different that he discovered that he had been taking Librax®, a sedating medication, by mistake—the "V" on the original prescription had been mistaken by the pharmacist for an "L."

Thirty years later, more than three-fourths of physicians are still scribbling prescriptions and look-alike and sound-alike errors are still being made. Although digital tools such as handheld prescribing devices and electronic health records are now available, only about 20 percent of us use them, and alas, our handwriting has not improved.

The truth is we have a long way to go. While there may be more programs to increase public awareness and better safety checks, the situation is also getting trickier for savvy patients, like Leslie, who want to do their part. State laws regarding notification vary, but pharmacy benefits managers don’t necessarily contact patients or physicians when formularies are changed, and unless your doctor specifies that a brand name drug be dispensed, you will likely receive a generic drug if one is available.

When Leslie called her health plan’s mail-in pharmacy she was told that there should have been a label stating that it was indeed the same drug even though it looked different. If you find yourself in the same position, there are quite a few medication web sites and books such as the 2008 Consumer Reports Drug Reference Book that provide drug photos, drug identifiers and other important drug information tools.

To help ensure you are taking the right medication for the right condition at all times, the Agency for Healthcare Research and Quality advises:

• Read your prescription. If you can’t read your doctor’s handwriting, your pharmacist might not be able to either.
• Know what your medicine is used for. Ask your doctor to write what the medication is being prescribed for directly on the prescription. Ask questions!
• Try to use the same pharmacy. Pharmacy databases can catch many errors including duplication of medications (I once had a patient come in on Ultram®, Ultracet® and generic tramadol—all three containing the same pain medication, all from different pharmacies, an error that would have been avoided with one pharmacy). A pharmacy’s computer can also check for drug-to-drug interactions and dosage errors.
• Make sure that the medicine is what the doctor ordered. Does the label vary from the prescription or look different than what you expect? Does a refill have a different shape, color, or size than what you were given before? If anything seems wrong, ask the pharmacist to double check it.
• List all the names of your medications, vitamins and supplements. I advise all my patients to do so. It will help coordinate your care if you have multiple doctors, and keep you safer if you need to see someone as an emergency. One of my patients showed me her trick—she jots down her meds on an index card laminated with extra wide scotch tape to make it waterproof.

—Orly Avitzur, M.D., medical adviser to Consumers Union

Read more on how to avoid common medication mistakes and how to manage multiple medicines.

Comments

[Michael Roth]

As a practicing pharmacist for about 30 years, I am not only exposed to prescribers poor handwriting, but place even more blame on the hundreds of different insurance companies. Patient's are constantly being flipped to different insurance companies through a change of employer, or an employers decision to change plans. The formularies with each company vary, and most of a pharmacists time is spent talking to insurance company clerks to clarify plans, formularies, whether a patient can receive that prescription today, or must wait a certain period for a refill or a new prescription that may be in the same class. Meanwhile the insurance companies are all building huge buildings while they duplicate services, confuse patients, prescribers, pharmacists with multiple different rules. I practiced in the retail world before the advent of "INSURANCE RULES" and have seen the changes. Universal coverage with single payor seems to be the only way to resolve the changes that occur when the company makes a new deal, changes to a different generic, or whatever. Also insist that prescribers transmit a readable document through electronic prescribing or something similar. Why gamble with patients lives, because the MD,DO,PA,CNP,OD or whomever currently writes an RX that looks similar to childs scribbling?

[John Grace]

Pharmacist Roth is right on point. The Single Payor concept is the only plan that will eliminate the Insurance Company bureaucracy's stranglehold on America's health and return the dollars wasted on their outrageous profits into real care for families that need it.

[Cleaves M. Bennett MD FACP]

Too many Americans are taking some or many of the drugs used to counteract an unhealthy diet and lifestyle. Someone in their 30's or 40's taking blood pressure and cholesterol pills will have to take those pills everyday for the rest of their lives! Likely will have add more as they get older. As a doctor I have seen many patients who took the pills for years (not always faithfully or correctly) and then ended up in the hospital anyway, with all the problems the pills were supposed to prevent. I tell my patients "pills are like seatbelts. Seatbelts are lifesavers, but you still have to drive carefully!!"
I hold Big Food and Big Pharma responsible for the health care crisis. We live in a time of TOO MUCH food. Even poor people are getting obese. Go into any grocery store and look around. The size of 1 or 2 football fields, everywhere you look there is TOO MUCH. Everyone's baskets are TOO FULL. Remember when there was only "slow food"? Now you can stop at McDonalds and eat TOO MUCH while driving to work. Portion sizes are 50-100% bigger at restaurants now. In fact, a brilliant marketing ploy is “all you can eat”. Restaurants use adjectives (succulent, savory, juicy and tender) to describe the choices on the menu to make them irresistible. Scientific studies show that works. Big Pharma plays a vital role. They have convinced all of us, “if diet and exercise don’t work for you, take these pills and don’t worry.” We are one of only two countries in the world to allow DTC ads. On the ½ hour evening news, I can count 5-7 DTC ads for drugs to counteract unhealthy living. The viewers go to their doctor, ask for the drugs and of course she has samples from the drug reps. Worst example: “statins” for high cholesterol. Lipitor sales alone are north of $11 billions/year. I have an essay at my website nomoremedicines.com entitled “Bad Cholesterol is Good Marketing”. Most people taking statins get no real benefit other than lowering their cholesterol numbers. Studies done by Pfizer show only 1% of high risk patients avoid a heart attack or stroke by taking Lipitor for 5 years. Beyond 5 years there are no data. You start taking Lipitor in your 40’s you could be taking it for 30 years. After 5 years you are on your own. Not even your doctor knows if Lipitor is still helping you. (It is still helping Pfizer’s bottom line though.) Get the message? Our only hope; your only hope: eat and live healthfully. Live long enough to watch your grandchildren grow up. I got health religion in my late 30’s. SAVED MY LIFE! I am still active and in great shape at age 74. If I can do it so can you.

[jean mahrous]

A few months ago, I visited my PCP because of painful leg cramps at night. He gave me a prescription for what I believed was potassium. When I stopped in the pharmacy on my way home (late Friday afternoon), neither he technician nor the pharmacist could read the script. As an alternative to waiting until the physician could be called on Monday, I tried the Walmart pharmacy and no one there could deciper the script. I then went home and showed it to my husband, who has been in the pharmaceutical industry since 1981 and is currently a practicing pharmacist; he could not deciper it. I have two sons who are physicians in another state and I faxed the script to them. One said it was the worst handwriting he had ever seen and neither could read it.

The following Monday I took the script back to the pharmacy and left it there until they could call my physician and find out what he had written.

[Pharmacy]

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