There’s an interesting and informative medical blog out there called Clinical Cases and Images: Casesblog that I follow in my RSS reader and it recently pointed me to a paper published in the Archives of Internal Medicine in 2006.^[1] The authors of the study combined information from surveys of patients and physicians with the coding of transcribed audiotapes of office visits with a variety of physicians – family physicians, cardiologists, and internists, in order to quantify the quality and types of information patients typically receive about newly prescribed medications.

I think most physical therapists assume that patients understand something about each of the medications they take. Or at the very least, that the patients were informed about the medications when the drugs were prescribed. This study questions that assumption.

What would you want your patients to know about their medications? The medication name? Check (duh). The reason the patient should take the drug? Check. How long the patient should use the drug? Yep. The adverse effects of the drug? Check. The number of tablets to be taken and the frequency or timing of taking them? Check, double check (duh again).  These are exactly the questions the investigators tracked during 860 office visits of 909 patients. New medicines were prescribed during 185 of these visits and the audiotapes and surveys of the patients and physicians involved in the visits served as the data used in the analysis.

What did they find? They found that our assumption that patients have been told about their medications by the physicians prescribing them is a dangerous one:

• 13% of the time, physicians didn’t provide their patients with a justification for taking the medication
• 66% of the time, patients weren’t told if or when medications could be stopped
• 45% of the time, patients weren’t told how many tablets to take or sprays to use
• 42% of the time, patients weren’t told how often to take a new medication
• 65% of the time, patients weren’t told about adverse effects they might expect

All in all, physicians failed to communicate almost 40% of the expected information about new medicines to patients. If the recommended drug was available over-the-counter, patients were only provided with 50% of the information they’d need to use the drug correctly and understand why they needed to take it.

Certainly, patients get information about their medications from sources other than the prescribing provider. Pharmacists and drug packaging probably supply some of that knowledge. But it is clear to see that all sorts of problems might arise if patients don’t understand why and how they should take their medications. Get that medication history from your patient, but make no assumptions that it makes sense,  and no assumptions that your patient is taking those medications as they were prescribed. If it doesn’t make sense to you, ask.

Back to text 1. Tarn DM et al. Physician communication when prescribing new medications. Arch Int Med. 2006;166:1855-1862.