How would you answer this interview question?

[mrh125]

"You have a 65 year old patient on medicare with fixed incomes and she is on BP meds. You see her in the office and find her having a high blood pressure. You ask her if she is taking her medications and she swears she is. Who would ask to find out if she is really taking her medications?"

I keep seeing reoccurring questions like these and i'm not sure how to answer them. Obviously, I'd ask her because that's a given. Other options include a significant other, caregiver or pharmacist because they all may have the context-specific exposure to her that may allow them to see if she's been taking her meds. There's got to be a better answer than this though. Any ideas?

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[LMBLBM]

"You have a 65 year old patient on medicare with fixed incomes and she is on BP meds. You see her in the office and find her having a high blood pressure. You ask her if she is taking her medications and she swears she is. Who would ask to find out if she is really taking her medications?"

I keep seeing reoccurring questions like these and i'm not sure how to answer them. Obviously, I'd ask her because that's a given. Other options include a significant other, caregiver or pharmacist because they all may have the context-specific exposure to her that may allow them to see if she's been taking her meds. There's got to be a better answer than this though. Any ideas?

I would make her sign HIPAA waiver or something so that I can ask her significant other or caregivers.

 

[akhart]

Maybe ask her specifically about her routine. Does she have a pill box with daily meds? Does she always take them with dinner? Ask how she tracks it. Also ask if there are any side effects or she has any concerns about taking it. Have no idea if this is a good answer was just thinking of how I know if my mom takes her meds.

 

[frosted_flake]

Well the pharmacy would know if she was filling the prescription or not, and I can't imagine she would fill it and then not take them.

 

[mrh125]

Well the pharmacy would know if she was filling the prescription or not, and I can't imagine she would fill it and then not take them.

My thoughts were like that as well and it'd provide more info if she consulted the pharmacist for instructions. Just to fuel the discussion, she could fill it and then find out about something that worries her like how almost every medicine has a sudden death side effect or she may have heard something negative from her friend and worried. or maybe she has alzheimer's and can't remember. the possibilities are endless .

 

[masaraksh]

She could be not taking it since she can't afford it. Ask some questions probing along that path.

wtf, is this 'question the pharmacist' crap. what if she picks up her meds at walgreens or something.

 

[frosted_flake]

When I have seen patients not taking their medications, it is most often times due to them not being able to afford it. Other times I have seen dementia patients take the pills out of their 'box' and either throw them away or put them some place 'special' as the call it... ala: not taking them.
@masaraksh : Walgreens (either the tech or the pharmacist) can tell if the prescription has been filled and when it was last filled.

 

[NickNaylor]

In a clinical setting we would likely check the online prescribing database to see if the prescription has been filled. Calling the pharmacy would have the same effect.

Asking family members probably isn't the right thing to do. There's no guarantee that they would know the information or that it would be any more accurate.

I suppose in the land of interview questions anything is possible, but if the patient said they were taking their meds and you otherwise had no reason not to believe them, you would likely assume that the med isn't working and increase the dose or add another medication.

 

[FluffyPolishUnicorn]

Check her blood for the blood content for that given drug?

Also ask questions like other said about patients routine for the day and how he/she keeps about the daily tasks.

 

[ccantr10]

If she has the prescription bottle with her, count the pills. Otherwise, ask her to bring the bottle with her for a pill count. That's what we did at the practice where I worked.

 

[allantois]

Maybe try to first make sure she understands what medication she is taking? Some older folks have so many meds and they honestly don't even know why they were prescribed them and may confuse different prescriptions (e.g. two white pills of the same size).

 

[2Pints]

Check her blood for the blood content for that given drug?

Also ask questions like other said about patients routine for the day and how he/she keeps about the daily tasks.

Very rarely would we test pharmacokinetics for a case like this. In the hospital setting, at least, we test for illegal drugs, aspirin, alcohol, and maybe a few others. We draw an INR (international normalized ratio) that can indicate if the patient is therapeutic with their coumadin. The only time I've ever seen pharmacokinetics draws, as a nurse, are for a clinical trial. Besides you'd have to get consent for that draw and if she's having trouble paying for her meds, I'd doubt she be able to afford the additional lab work.

That'd be nice though if we could easily test for patient compliance. Like other people have stated, the fact her BP is so high though indicates she's either 1) not taking the meds as prescribed and needs more education after determining cause of not taking or 2) her prescription needs to be changed

 

[el_duderino]

It would be insulting to count the pills in front of her or ask her family. If checking with the pharmacy is an option, that's a good one. The more tactful route is to ask if she's noticed any side effects and how severe they are, how much money she has to pay for the meds, etc. If she's not taking them, it's for a reason, and if you get her talking about the negative aspects of the pills she might cop to it. I think it's important in this situation to smile and do what you can to make her feel comfortable. You're the physician - you're there to help her, not to judge her or command her. Making the patient feel bad or afraid of you is not going to help compliance or honesty.