It’s your health, not mine

All too often, I find a patient in the back of my truck who has absolutely no knowledge of their own health. None. And it’s frustrating. I’ll stereotype by saying that the majority are men, many are under- or uneducated (by their own admission), poor and minorities. This description does not fit all of the patients I have had, nor does it fit everyone who lacks concern for their own health, but it tends to be a good stereotype (and it’s just that…a stereotype).  Here are two patient’s I’ve had recently:

The first is a middle-aged man who lives in a middle-class neighborhood. He works and enjoys what he does. He lives with his wife and four teenage/college-age children who are all home for summer break. We are called out because this gentleman has an unwitnessed syncopal episode (he passed out). He’s up now and feels fine, except for the abrasion on his forehead and his knee. Upon further assessing of this patient, his blood pressure is noted to be exceptionally high and, even though he has a history of this, it is a cause for concern. Because this problem has happened once before and he didn’t get it checked out and in conjunction with the hypertension, he agreed (with the strong pushing of his entire family) to go with us to the hospital. His wife handed me a gallon-sized Ziploc bag full of medicines. As I am going over the medicines with the patient on the way into the hospital, asking why he takes them, he tells me he doesn’t know and that I need to ask his wife. He says that he takes whatever his wife gives him and that he doesn’t know what he takes or why he takes them. All he could tell me was that he had yet to take his nighttime medicines (it was about 10pm) and the medicine he knows that he loves to dose up on is alcohol (of which he has had “6 or 8 beers” today, not an unusual amount for him, he says). Not only can he not tell me about his medicines and what he takes when (i.e.: does he take his blood pressure medicine twice a day) but he is unable to tell me what medicines he is allergic to or his medical problems. He says that’s what his wife is for…and if his wife isn’t there, that’s what his daughter is for…and if his daughter isn’t there, that’s what his other daughter is for. (That was his line of logic. I think I broke him of that.)

The second is an elderly man who is poor and uneducated. He tells you that he can’t read and that he can’t write. He lives in Section 8 housing. He doesn’t work and lives from welfare to welfare check. You meet him on the side of the road when he says that he sat down because his legs were going to give out because they were so tired from walking. The patient has no complaints aside from leg pain in the hip and knee, which the patient says is chronic and gets worse when overused. Upon further assessment, the patient is noted to be extremely bradycardic (low pulse) with a rate in the 40’s and hypotensive (low blood pressure) in the low 90’s — however, still feels fine. This patient can tell me only that he has “the sugars” (diabetes) and can tell me about no other medical problems. He can’t tell me about any medicines he takes. He can’t tell me about any medicines he may be allergic to.

Know your medicinesEach of these men pose a serious issue to us. First of all, we need to know what medical issues our patients have. If either of these men had been unconscious, we would have treated them very differently based on the vital signs we found. The first one we would probably assume a stroke and the second one we would probably assume a heart issue — though that wasn’t the issue for either of them. The first just had not taken his blood pressure medicine for the evening and the second, well, we still don’t know (his blood pressure dropped even further by the time we got to the hospital — but he still felt fine…curious, no?). If we come across an unconscious person, one of the first things we will do is to open up the patient’s wallet and see if there is an easily identifiable medication list that we can access. In that list, we hope to find the patient’s medicines with dosages and the frequency that the medicines are taken, allergies to medicines with the reaction that the patient experiences and medical problems. It is always helpful if there is a list of the patient’s doctors and also an emergency contact in there.

It’s great if you have a list. But. It does no good if that list is at home and you are out. You’ve got to carry it with you. I also understand how helpful these lovely pill boxes are (seen to the right). Please, please, please understand that if you hand me a pill box with a multitude of multi-colored pills inside, I don’t know what each of them are any more than you do. Yes, I can identify that this one is oblong and blue and that one is square and yellow and this one is round and white…but that’s about it. I understand that these make life easier (if, indeed, you are able to keep straight what day of the week it is, unlike myself and most of my coworkers on most days). I get that. I do. However, when you are at home, you need to keep the bottles (yes, these little things seen to the left) close at hand, particularly if you don’t have a list anywhere nearby.

I promise you that I am not just preaching this to you. I carry a list of my medicines with me at all times. I may be a mid-20-something who has only a few medicines that I take but I understand the importance of knowing what I take, how often I take it and the dosage of each medicine. I understand that indicating any allergies that I have is important and communicating the particular medical issues I have is also important. On my list, I also have my address, my birthday, my phone number, my doctors (to include the name of their practice and the accompanying phone number) as well as my emergency contact. (I include all of that information because I know what my EMS agency would look for in the event I were unconscious and taken in by ambulance. I also know that everything, except my phone number, is already on my license and therefore not private in the event my wallet were stolen.) In fact, I just updated my list today as I was writing this, realizing that my address and, well, my name were no longer current. I have printed out the page, folded it up, marked it well so that it can be easily identified in my wallet and also indicated when it was last updated.

Here are a few websites that just by doing a simple Google search (for “patient’s medicine list” but I’m sure you could get even more creative) I stumbled upon. They will help you keep up with your medicines, medical allergies (no, we don’t particularly care that you’re allergic to dust unless your allergy [like peanuts] requires you to carry an Epi-Pen) and medical problems. Some of these appear better than others and I’m sure there are plenty more out there. It can also give you a good starting point for making your own list. Keep in mind also that it is good to have back-up copies such that if something happens you can simply give your copy to EMS or the hospital and not have to fret over getting it back. (Believe me, in the middle of something bad happening, our last thought is “ohh…we need to give the patient their med list back.” So, trust me when I say to have a back up. It’s less frustrating for you and us.) We also appreciate lists that are typed and not hand-written. You may be able to read your handwriting…but not everyone can. Please be conscientious of that. It also provides you a method for which to have a backup (saved on the computer! How smart! 😉 ) instead of having to write out your backups. For those of you who have parents and grandparents (i.e.: people who are most likely to need it) who don’t have computers or a means to mass produce a list, please encourage them to let you help them with this. It will save everyone a lot of headache when the need arises.

My Medicine List — scroll to the link that says Print “My Medicine List”. Also, if you look further down on this page, it provides you with information you should know about each medicine you take, like what condition you take it for, how you should store it, what you should do if you miss a dose, etcetera. I encourage you to learn these things if you don’t already. It also provides some safety tips, like to keep your medicine list up to date (**extremely important**) and to not stop taking medicine just because you feel better (it means it’s working).

Safe Care Wisconsin — yet another medicine list. This gives you the option of using Adobe or Microsoft Word for opening the list. As they say, list it, don’t risk it. Write down your medicines and carry the list.

I hope this helps you and encourages you to take a better and stronger interest in your own healthcare. I can’t do it for you. As much as I would love to have an instant knowledge of what medicines you take, your full medical history and what’s currently wrong with you, I can’t. You have to help me out with that. I hope you can help me and all of my colleagues out with that.