Irreconcilable Differences
13 Jun 2008
Verapamil SR 240mg/day. Protonix 40mg/day. Aspirin 81mg/day. Xanax 0.5mg PRN. Zocor 20mg/day. Not an uncommon list of medications for one of my patients. All important, some needed daily and some can be missed for a little while. But, this is just a list, not a set of instructions for building a nuclear power plant. This type of list is a good indication, a set of road signs if you will, of what other issues a patient I am asked to see faces other than their surgical problem. How I need to deal with each of them varies, depending upon the medication, the patient, their anticipated surgery, and the length of time they will be hospitalized. That’s a funny little game we like to play, called "being a doctor." However, the bureaucratic bastards otherwise known as The Borg JCAHO don’t want us to use our brains. They view the patient’s list of medications as the Word of God, not to be tampered with, to be accepted as Gospel from the patient. Of course, this view is not to be tainted with the suggestion that, well, some patients really don’t know which medications they take, or how often, or what dose is involved. It is THE LIST!!! It is to be FOLLOWED!!! And, most importantly in this bureaucratic sinkhole our hospitals are collapsing into, it must be RECONCILED!!!! Yes, comrades, in its infinite wisdom and compassion, the Politburo JCAHO decided to mandate that every patient who is cared for at a hospital must have a Medication Reconciliation Form filled out. In theory, this is a pretty good idea — the folks caring for a patient should know what meds, at what doses, a patient is taking. The "reconciliation" part comes in deciding which meds to continue, which ones to stop, which ones to change, etc when a patient comes in the hospital. For the majority of my patients, nothing changes; they continue on as before surgery with no alteration in their medications other than the addition of some pain medication.
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