No. 1 Rule for Safe Drug Use: Have ‘Brown Bag Sessions’ with Your Primary Doctor; Fill Out a Drug Worksheet

The following article was adapted from the 2005 edition of our book, “Worst Pills, Best Pills.”

Whenever you go to a doctor you have not previously seen or go to one with whom you have never had a brown-bag session, gather all prescription and over-the-counter drugs and dietary supplements in your medicine cabinet and bring them to the doctor so that a list can be made and you can start to fill out a drug worksheet.

The purpose of the drug worksheet is for you and your doctor (or doctors) to keep an ongoing record of all drugs you are using, the purposes for which they are being used, their side effects and other essential information. It is impossible to overemphasize the importance of this first and most crucial step in preventing adverse drug reactions.

Doctors should never prescribe a drug or renew a prescription without full, up-to-date knowledge of all drugs already being taken or likely to be taken. Before your brown-bag session with the doctor, your pharmacist may help you to fill out parts of your drug worksheet.

Once you have brought in all the drugs you are taking, ask your doctor to help you fill out the worksheet. You will probably be able to fill out more of the information concerning over-the-counter drugs yourself, while your doctor will be able to help you to fill out most of the information concerning prescription drugs — at least the ones that he or she has prescribed for you.

Explanation of items on drug worksheet

a. Name of drug, of doctor who wrote the prescription, and date drug was started or the dosage changed: Drugs should be listed by both brand and generic names, because both are commonly used. All drugs prescribed by all doctors should be listed. Over-the-counter drugs and the amount of alcohol, tobacco, and caffeine used also should be indicated. There are many dangerous interactions between drugs and between drugs and alcohol, so this information is extremely important.

b. Purpose of the drug: Identify the reason for which each drug is being taken. Often, because physicians are frustrated at not being able to do anything else for the patient, or because the doctor believes that the patient will not be satisfied unless a pill is recommended, prescriptions are written without a valid medical reason. In one study, patients reported that about 1 out of every 4 times (25.4 percent) they received a prescription, they were not told the purpose of the drug being prescribed.

c. Dose, frequency of use and duration of use: It is important to know what the dose is, how often it is supposed to be taken, at what hours and for how long.

d. When the drug should be stopped or the need for its use re-evaluated: For any drug, new or old, you should assume that it should be used for as short a time as possible unless there is evidence that its continued use is necessary. An exception to this is the use, for a prescribed period of time (even if you are feeling better), of antibiotics. Evaluation at least every three to six months of the need for each drug being used will reduce the number of drugs being taken. For some drugs, such as tranquilizers, sleeping pills, antidepressants and others, much more frequent re-evaluation is necessary.

e. Important possible adverse effects of the drug: Because many of the most serious perceptible adverse effects of drugs are often wrongly attributed to such things as “growing old” (such as falling, memory loss, depression and many more), it is important for patients to know about the adverse effects of the drugs they take so they can recognize and report them to the doctor. In one study, researchers found that 37 percent of documented adverse drug reactions had not been recognized by patients and reported to their doctors, and that the majority of these patients had not been informed about possible adverse drug reactions by their doctors.

f. Important possible drug and food interactions, especially with over-the-counter drugs, and diet recommendations: Ask your doctor which foods and other drugs taken along with your drug can interact and cause adverse effects, and ask for dietary recommendations.

g. How you are actually taking the drug: Always be straightforward with your doctor about whether or not you are taking your medicine and how often. Do this even if you had no defined reason for stopping. This is important because not giving your doctor this information can lead to mistaken conclusions about what dosages or drugs work.

h. New problems or complaints noticed by the patient, friends or family since any drugs been started: As mentioned above, patients themselves often do not notice a change, especially older adults who are inclined to blame many of their problems on aging. Friends and relatives are often the first to notice adverse drug reactions, especially ones that affect thinking or mood. An additional difficulty is that patients are often reluctant to tell their doctors that something the doctor did to try to make them better actually made them worse. The safest assumption is that any worsening of a patient’s condition or any new symptom that develops after a drug is started is an adverse drug reaction until proven otherwise.

i. In the judgment of you, your family and your doctor, is the drug working? Have the purposes for which the drug is being prescribed (as in b) been achieved?

Worst Pills, Best Pills Drug Worksheet (PDF)