Thank you for publishing Dr Laycock’s review of the uncertainties inherent in the current methods used in driver assessment (BCMJ 2011;53:74-78). I agreed with his position in a letter I wrote to Canadian Family Physician (“Doctors should not evaluate competence to drive,” 2011;57:170).
On a different topic, I am following a middle-aged patient whose kidney function is declining rapidly. In October the eGFR was 27 ml/minute. Last month the patient went to a walk-in clinic complaining of gout. The doctor prescribed naproxen 500 mg X 30, 1 p.o. t.i.d. A pharmacy issued the tablets. The patient’s next eGFR was lower than 27 ml/minute.
The nephrologist was disappointed that the patient had been prescribed an NSAID. I called the pharmacist who issued the naproxen. She said, “Our staff did not know what the patient’s eGFR was.” Two other pharmacists have confirmed that they usually do not know about the status of a patient’s kidneys or liver, and that they would appreciate knowing why a drug is being prescribed. For example, is ramipril being prescribed to treat arterial hypertension, congestive heart failure, or diabetic nephropathy? The pharmacist can counsel the patient better if he or she knows about a patient’s medical conditions.
I suggest that we write the indication for the medication on the prescription sheet. If it is the first time you are communicating with a pharmacy, also indicate the patient’s important medical conditions, allergies, the creatinine or eGFR, and the hepatic transferases (if the lab results are abnormal).
—Robert Shepherd, MD
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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