“The family of Mrs Schmidt was very pleased with your medication review!”, the nurse commented at my routine visit to the retirement home.
“Thank you. That’s nice to hear.”, I was happy to hear about the positive feedback, except I couldn’t recall who Mrs. Schmidt was.
I looked up my file and reviewed my notes. Oh yes, I remembered. She was a German lady who recently moved to Canada. The nurse wanted me to review her medications to see if there was anything worth tweaking.
I took a look at the very thin chart. There was hardly any information, very little info on her past medical history, no lab results but she was on tons of pills. Without much history or information, I went to visit Mrs. Schmidt. I introduced myself.
Here’s how our our conversation went:
We spent half the time talking about how she was a hard working lady growing up in Germany, why she came to Canada, how she disapproved her kids’ liberal parenting style and many other topics that really didn’t pertain to her medications. But the rest of the time, I couldn’t understand her because she was mumbling in German. I just nodded my head, showed some empathy and hoped she would pause a bit to let me talk about her medications.
No it wasn’t just random talk. I observed her gait, her cognition, her ability to recall past events, any shortness of breath. I saw a cane but she wasn’t really using it. Her medications revealed few key information. She probably had mild cognitive impairment, some cardiac history, likely mood or anxiety concerns based on the medications she was taking.
My assessment was that she had some health issues but she seemed stable.
So I asked her what I could do to help with her medications. She told me she didn’t like her sleeping pills. She was referring to her nortriptyline and trazodone. She had been diligently refusing them over the past several weeks. So I told her I would ask the physician if we could get rid of them.
I also noticed that she was on two antiplatelet medications, so I said I would check with the physician if he would stop one of them too.
We ended our conversation and she thanked me profusely. I wrote up the recommendations and left them with the nurse.
There was nothing spectacular about the visit, nothing I did that was great. In fact, I spent a good 20 minutes listening to Mrs. Schmidt’s life story with the last 5 minutes working up some clinical issues. But that’s typical for a medication review in a retirement home.
But according to the family, it was great. It was great not because I was able to apply any sophisticated clinical knowledge. It was great not because I solved an important mystery in her drug therapy. It was great not because I was doing amazing work.
It was great because I took the time to listen to Mrs. Schmidt. Many elderly individuals only yearn to have someone talk to them, give them a bit of attention, show them some love and respect.
That’s my secret to a great medication review!. Listen, assess and make recommendations based on the patient’s wishes… and of course the usual work up that I have been trained to do.
Thank you for reading and have a wonderful Long Weekend!