What's in your wallet?
Do you have a written list of the medications you take?
If not, it might kill you, as it does thousands of people each year.
Lack of an accurate medication list also makes it much more difficult to choose Medicare prescription drug coverage. The Medicare open enrollment period is in effect now, and ends Dec. 7.
Medicare Part D — prescription drug coverage — is a crucial and complex part of an often confusing process for many Medicare-eligible seniors.
There are myriad factors in making choices about Medicare, the federal government's health-care plan serving mostly those age 65 and older. But whatever a person's situation, seniors taking medication on a regular basis can make better choices for themselves by taking the time — or asking for help — in compiling that list of medications.
Having an accurate, up-to-date, and legible list of medications in your wallet or purse can be crucial if you end up in an emergency room, alone and unconscious. But just being awake isn't always enough.
"It's a big problem," said Dan Hyman, head of Internal Medicine at Cooper University Health Care in New Jersey. Even when they are conscious, Hyman said, "people are sick, upset and don't remember or forget to tell us."
The nonprofit and independent Institute of Medicine estimated in 2006 that there were 1.5 million "adverse drug events" a year, but guesses that the true number might be higher. Many of those are in hospitals, but many others are in homes. A study in the Lancet estimated that 7,000 people die each year from medication mistakes.
Cooper gives patients in its system wallet-sized cards listing their medication, but Hyman said getting updates and information from out-of-network doctors remains a challenge.
Jeanmarie Perrone, an emergency physician at the Hospital of the University of Pennsylvania, said a "great proportion" of the people arriving at the emergency room can't remember off the top of their head what medications they take, assuming that they are conscious upon arrival.
"They are trying to be helpful," she said, "but saying, 'It's a red pill,' doesn't help us at all."
Tremendous progress has been made in recording patient information in electronic records, but sharing and updating of information is still lacking, especially when patients get prescriptions from multiple doctors who are not in the same health-care system.
There are websites, computer programs, and apps for smartphones that can help patients keep track. But those appliances, along with taping it to the refrigerator in the kitchen, have limits.
For emergency purposes, lists should include the drug name, dosage and how frequently the patient takes the drug. If there is room on the list, the reason for taking the drug, and the prescribing doctor's name and phone number can help.
Knowing all of that can help patients have more intelligent conversations with doctors. Is the brand-name drug the best one or can a cheaper generic suffice?
Each list should also include over-the-counter medicines, vitamins or supplements that a person has taken recently or uses on a regular basis.
The Institute for Safe Medication Practices, led by philly.com health blogger Michael Cohen, has a link on its website to eight pages of medications that are easily confused with another drug of a similar name.
"The reason you are seeking care might be related to an adverse effect of a medication you're taking," Cohen said by email. "Also, current medications may impact treatment decisions. Another reason is to avoid duplicate dosing and drug interactions. For example, the doctor might want to prescribe a drug that is in the same class as one you are already taking or may interact with a current medication."
Perrone said patients frequently forget to mention one of the most commonly prescribed medications for seniors — blood thinners — and that could change emergency room treatment because of fears of internal bleeding.
The Camden (N.J.) Coalition of Healthcare Providers, which is famous in health-care circles for innovative approaches to improving care and reducing costs for some of the most expensive patients, has nurses visit homes.
"Sometimes we see a real mess, with piles of duplicate and outdated medicine," nurse Jason Turi says. "We try to help them with pillboxes and lists and understand why they are taking them, inspect the medicine and communicate the list to providers."
"The pie-in-the-sky dream," Cooper's Hyman said, "is if you're here visiting from California and part of a health plan there, I can access your list of medications and see the report from the doctor you saw last week."