Read the medication list first

By Anita Gupta, DO, PharmD, MPP, Johns Hopkins Medicine

As both a pharmacist as well as a pain medicine specialist, I read the medication list first. Many clinicians read it last and may view it as a box to check before the critical work of the patient visit begins. My pharmacy training made that impossible for me. Often, reviewing the medication list is an important part of the patient encounter. This is especially important if you weren’t the one that prescribed the medication—it gives you a glimpse into what each clinician was thinking at the time of prescribing.

What a medication list revealed

A few years ago, a woman came to my pain clinic with chronic pelvic pain. She’d already seen three specialists and her chart described her as “anxious.” Her medication list said she took a benzodiazepine for sleep, an SSRI for mood, an opioid she’d been on for two years, and gabapentin. These were prescribed by four different doctors who, as far as I could tell, had never spoken to one another. It seemed that nobody had asked the obvious question: What if the pain was real, and everything else was the fallout of not being believed?

The PharmD discipline—reconcile before you add

That’s the question I learned to ask in pharmacy school and training. Pharmacy school drills a specific discipline into you: before you add anything, account for everything already there. Reconcile. Look for the interaction, the duplication, the drug treating the side effect of another drug. It’s detective work, and it starts from the assumption that the list has a story to tell.

The gender pain gap, in prescriptions

Women’s pain often gets rewritten by clinicians as something else—anxiety, stress, hormones—and the medication list shows the account. I’ve lost count of the women whose charts described them as “difficult,” while their prescriptions described a person in pain—sedatives layered on opioids layered on antidepressants—each new drug papering over the fact that the patient’s original concern was never taken seriously.

The pharmacist’s vantage point

The pharmacist often sees this before anyone. At the counter, in the chart, in the refill line, the pharmacist is sometimes the only clinician looking at the whole picture. That vantage point is a form of clinical excellence we don’t often name. It isn’t a procedure or publication. It’s a habit—read the whole list, believe what it tells you, and ask the question nobody has asked.

Believing women’s pain doesn’t require technical ability or new science. It requires reading what’s already written, carefully, and all the way through.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.