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 [9]). I agreed with his position in a letter I wrote to Canadian Family Physician (“Doctors should not evaluate competence to drive,” 2011;57:170 [10]).

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
Victoria