The medication list a patient recites is the list of drugs they still have. It leaves out the one they stopped three weeks ago because it made their legs ache, the one the pharmacy had no stock of, and the one they halved because a relative said it was too strong.
So change the question. 'Has anything been stopped or changed since I last saw you?' finds different information from 'what do you take?', and it finds it faster than reconciling the list against the record. Ask it before you conclude that a drug has failed, because a drug never taken has not failed.
The follow-up question that pays for itself is why. Cost, a side effect, a rumour, or simply running out are four different problems with four different fixes, and only one of them is solved by prescribing something else.
- Ask 'what have you stopped or changed?' as a separate question from 'what do you take?'
- Always ask why it stopped - cost, side effect, stock, or belief need different responses
- Check the refill date on the record before deciding a drug is ineffective
- Ask about halved or alternate-day dosing; patients rarely volunteer it
- Record the reason in the notes, so the next clinician does not simply re-prescribe it
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