It is a well-worn ritual.
Near the end of your medical visit, the doctor gives you a prescription. Traditionally, it is handwritten and because calligraphy isn’t a prerequisite for medical school, you may not be able to read it.
Most patients are like polite travellers in a foreign country. They may not understand everything that was said, but they’re willing to take a leap of faith and assume they got the gist of it.
That may be a big risk if you’re travelling close to the border of a hostile country or about to take a potentially dangerous drug.
An important principle in medical ethics is informed consent. In order to make a decision about what treatment – including medication – to take, you need sufficient information.
So what should you know before you fill that prescription?
There are five crucial areas of information summarized with my acronym, BRAIN: Benefits, Risks, Alternatives, Interactions and the Need for follow-up.
The first question you need to answer is, “What is this drug for?” (i.e. What are the intended BENEFITS?) That’s what your family will ask when you get home. So if you’re not sure, you should ask before you leave the doctor’s office.
It’s not unusual for a patient to come out of the hospital or a clinic with five or more medications but not know what each is supposed to do. Doctors don’t mind clarifying this. We don’t want you to be on any more medications than you need.
The second area of information you need to know are the RISKS of taking this medication. These are the potential side effects. You won’t get every single side effect listed in the pharmacy handout. Only a few lucky winners will hit the jackpot. Like most lottery players you may not get any at all. However, as doctors, we should tell you the common side effects and the serious side effects (even if they are rare).
For example, the common side effects of oral steroids, such as prednisone, are immune suppression, insomnia, osteoporosis, stomach irritation and ulcers. A rare but serious side effect is avascular necrosis of the femur that may require a hip replacement.
Many drugs cause nausea and changes in bowel movements. Most drugs – including herbal remedies – have the potential for allergic reactions.
The third question that should be answered is, “What are the ALTERNATIVES?” What are the risks of not treating this condition? Are there other medications – cheaper or more expensive, synthetic or natural? Would lifestyle changes (i.e. a better diet or more exercise) be sufficient?
The fourth important area of information you need is the potential for INTERACTIONS with food or other drugs. Grapefruit juice interacts with many medications. It can raise the blood levels of many cholesterol-lowering drugs and increase the risk for side effects. The blood thinner, warfarin has to be carefully dosed in order to be effective in preventing blood clots without increasing the risk of bleeding. Many medications interact with warfarin, including non-prescription acetaminophen (Tylenol) and vitamin K (present in many foods, including green leafy vegetables).
Finally, the fifth area of information you require is the NEED to follow up. If this is a short-term prescription – such as a course of antibiotics for an ear infection, should you return to the doctor if you’re not better? How long should you wait?
If the prescription is for a chronic condition, such as diabetes or high blood pressure, how often should you be monitored? When should you be rechecked?
Autonomy is a cornerstone of western medical ethics, but to make informed decisions about your health, you need this important information. If you’re not sure, ask these questions and pick your doctor’s BRAIN.