What do you do when the red check-engine light comes on in your car? Most people realize that this is a warning of a potentially serious problem. They pull over right away to find out what’s going on.
Others, however, cross their fingers and hope they can reach their destination. Sometimes they get away with it. But if the car is low on oil, continuing to drive can destroy the engine.
In medicine the equivalent to the check-engine light is often a warning that pops up on a computer screen. When a doctor writes a prescription on a hand-held device or office computer, a program checks the other drugs the patient is taking. If there is a potential incompatibility, the program generates a warning.
How the doctor reacts to this alert can make a life-or-death difference for the patient. Too often, physicians may override drug interaction notices.
A study conducted at six Veterans Affairs medical centers found that there were nearly 300,000 interaction overrides in one year (American Journal of Managed Care, Oct. 2007). Roughly three-fourths were for interactions considered “critical.” In such cases, doctors are supposed to justify the override but they failed to do so more than half the time.
Interactions are responsible for many of the adverse reactions people suffer from medications each year. Michael Jackson, Anna Nicole Smith and Heath Ledger all died because of drug interactions.
Their deaths got a lot of publicity, but you don’t have to be a celebrity to suffer a deadly drug interaction. Millions of older people are taking handfuls of pills daily. Far too often the potential for trouble is overlooked.
Even young people may be at risk. Thousands of veterans have returned from Iraq or Afghanistan suffering from chronic pain, post traumatic stress disorder, depression or brain injury. These problems are frequently treated with antidepressants, powerful pain medications, anticonvulsants, sleeping pills and sedatives. Interactions among such medications can be deadly.
Doctors are not the only ones who override interaction alerts. Pharmacy computers also flag potential drug incompatibilities. Dealing with dozens a day may also lead to alert fatigue. A busy pharmacist may ignore or override such warnings in the hopes that nothing bad will happen.
Even when a pharmacist follows up on an interaction message by contacting the physician, the response is not always favorable. Many pharmacists have told us that their calls are sometimes ignored or dismissed.
That’s why patients and their families must be vigilant about potential interactions. One website worth checking is MediGuard.org. The interaction checking tool is among the best we have found. We have also prepared a free Drug Safety Questionnaire for the pharmacist and physician to fill out.
Just as no one should ignore the check engine light on a car’s dashboard, health care providers should not ignore drug interaction warnings on the computer. Blowing up an engine is regrettable. Harming a patient is unforgivable.
