In the wake of days of traveling, reintegration back to normal homelife, and 5 consecutive days of migraine, this post had to be put off a bit, but I wanted to share with you an experience that is all to common for me and other Servicemembers, and I suspect people in general.
I've shared on social media a bit about my various medical struggles as of late, and I will share a bit here shortly because I want to shed some light on the massive medical beauracracy that is the military medical system (which isn't all bad, once you figure out how it works), but there is one ongoing problem that continues to baffle me: medical history. The first issue (I can't even say worst issue) is medications.
On this past Thursday, I had 4 different medical appointments. I had just come back from some significant time out of the area, and I wanted to get as much done as I could before returning to work, so I stacked appointment after appointment on the same day. The first was a physical therapy assessment - not really many questions about medications, since that's not really what they are there for, but the medical history part was interesting - that's for another day.
The second was with a nephrologist. For those who are Googling that right now, let me save you the time: that's a doctor who specializes in the kidney. I had no idea that was a thing until I had painful kidney stones that decided not to pass and flare up whenever they feel like. This was my first appointment at this clinic, and the receptionist had already advised me to bring a medication list (thank you). I carefully wrote down every medication and supplement that I take including doseage as of that day and brought it with me to my appointment. I gave it to the receptionist when I arrived with the rest of my paperwork as instructed. I'm such a good patient.
I went back to the exam room when I was called and discussed my pain with the nurse. Then she asked me one of my least favorite questions ever: "So, what medications are you taking?" Fortunately, she followed it up with, "Is this list they sent from the base accurate?" and showed me a list she already had. Of course, it was not, but at that moment, the receptionist walked in with a scanned copy of my beautifully prepared list from that morning. I decided I liked this nurse a lot when she shared my disgust at how grossly inaccurate the list from the referring facility was.
I understand when you first visit a provider, you need to go through your complete medication list, and you can just provide updates after that. BUT - this was not what I took issue with. I got fed up with the medication issue at this visit, when the doctor came in.
Doc comes in with some notes on a 3x5 card. Oh, good. He read my chart. That's not always something that happens. He sits down at the computer, asks me some questions about my pain, discusses the CT where they found my kidney stones, and asks me, you guessed it: "So, what medications are you taking?"
Are you fucking kidding me, doc? I went over this with your nurse in this very room 5 minutes ago.
"I just went through all of my medications with the nurse."
"Oh well, what are you taking them for?"
"A lot of things. Maybe you can list off the medication and I can tell you what it is for."
I was fed up. This guy had clearly read all of the other things. Medications are clearly important, so why is it that he could not read this too? He seemed clearly irritated, but he did exactly that - went through the list his nurse had just made and I told him what the medications and supplements where meant to treat.
My third appointment was a CT for my foot that I broke almost a year ago and still hurts - more to follow on that another day too, but no medication issue with that one.
Final appointment of the day was my initial intake with a gastroenterologist. This appointment was on base. Let me preface this by saying that every prescribed medication I take is prescribed by a military physician and issued by a military pharmacy. Additionally, in order to get referred to the GI, they asked me that dreaded question, "What medications are you taking?" They even give you an alleged "medication list" every time you go in to primary care, which I have since stopped even looking at. When they give you this list, you are supposed to cross out the medications you are no longer taking, and write in the medications, including OTC and supplements, that you are currently taking, so that they can update your record. I used to do this dilligently, until I realized that no one ever updated the record. Never. Not once did I see this done. Nice idea in theory, but never acutally practiced.
So of course, I meet with the GI and he asks me, "So, what medications are you taking?" Fortunately, I had a copy of the exact list from earlier in the day that was returned to me at the nephrologist that I handed to that doc and he actually, no kidding, updated my medical record! Right before my eyes. It was amazing.
Why am I going on and on about something that seems kind of dumb? Several reasons.
1) It's increadibly dangerous. We live on base and the nearest ER as the base hosipital. If these had been emergency situations and the doctors at the base emergency room had been relying on my active medications list to determine how to treat me, they would have been sorely misinformed. I am clearly not on multiple antidepressants and multiple forms of birth control. As the nurse at the kidney clinic said "I'm assuming you're not on the pill if you have an IUD." Duh. Of course not. But these are not up to date. If there is a medication in there that thins my blood for example and one that doesn't, but they treat the same condition, how are they to know what I am taking in an emergency? This could be life-threatening.
2) It's frustrating for patients. I am a high-maintenance patient in the sense that I have a lot of medical stuff going on. It sucks - it's a lot to keep track of. If the folks maintaining my records are not doing their job in maintaining an accurate record, then I have to take the extra effort to make sure my record is accurate in order to ensure that I am getting the best treatment so that I get better. There are clearly measures contemplated for this (the medication list that is handed to me every time I go in to primary care) - if we would just follow through, it seems like we could avoid some unnecessary confusion.
3) It's frustrating for physicians. Based on the reactions of the two doctors I encountered on Thursday, it was clear that they also wished that my records were a little more complete than they actually were. Especially for the doctor who took the time to review the file before I arrived (I am not sure what the GI reviewed before I arrived, but he seemed totally with it when I got there - no complaints), I am sure he would have liked to have had an accurate medication list sent over from the clinic as he was contemplating courses of treatment.
The long and short of it is, it's not that hard to do better. Of all of my frustrations of the treatment of paitents in our medical system, this is the most minor. But sometimes, it's the most minor of issues that are the most annoying. Following through on this simple task could go a long way in improving patient care in very busy and overworked medical facilities.
