Two of today's findings turn on the same thing: what happens to a long-term medication when the context changes. An angiotensin-axis blocker started for hypertension five years ago meets an anaesthetist. A calcium channel blocker started for rate control meets a failing ventricle. In neither case is the original reasoning available.
The habit worth building is to read the admission list as a history rather than a status. For each drug, three questions: what was it started for, does that indication still hold, and does the acute problem change the balance. Most lists survive this intact. The ones that do not are where the avoidable harm sits — the antihypertensive in a patient who is now septic, the diuretic in a patient who is now dry, the rate-control agent in a patient whose ejection fraction has fallen since it was chosen.
This is the part of the job that does not appear in any guideline, because guidelines are written per disease and the patient has several.
- For every admission drug ask: started for what, still true, changed by this illness
- Record the answer where the discharge summary will find it, or the next admission repeats the work
- A drug that is right for the chronic condition can be wrong for this week
- Where you stop something, write when it should be reconsidered — an indefinite hold becomes an accidental discontinuation
- Ask the patient what they think each drug is for; the mismatch is often the finding
Why it matters
It is the one review that no single-disease guideline will ever prompt you to do, and the patient in front of you has four diseases.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free