There are three types of ‘drugs’ that patients take: prescribed drugs, street drugs (i.e. illegal drugs) and over-the-counter (OTC) drugs that anyone can buy in a drugstore, such as aspirin, tylenol, milk of magnesia, etc.

It’s important to ask the patient if they have taken any drugs at all in the past few days, and to find out what those drugs are.  For any drug they might have taken, you want to know: which drug? how often? and how much?  Remember that ‘drugs’ come in pills, creams, sprays, needles, and funny little ‘cigarettes’ (as well as many other forms) so don’t be afraid to prompt your patients to think of each of these.

If the patient is taking prescribed medications, try to bring their pill bottles with you when you take them to the hospital.  Read what pills they are taking.  There is an important medical skill called ‘bottle recognition’ or ‘bottle diagnosis’ and it consists of being able to look at the constellation of pills the patient is taking and deducing from that what medical problems they have.  For example, if a patient tells you that they have no medical problems and they are taking esidrex, hydrochlorothiazide and slow K, they have either forgotten, or are hiding the fact that they are being treated for high blood pressure.  Bottle recognition is not a necessary skill to be a medic, but you’re a pretty poor one if you don’t have it (IMHO).  Work on this skill.  When you start, keep a log of every medication that your patients are taking and summarize it every week, and then every month, and then every year.  After the first year, you should have a list of several dozen medications listed from the most to least frequent.  In brackets beside each drug, write a list of what the drug is for.  Be aware that some drugs (such as beta blockers) can be for multiple conditions.  List them all.  Practice your bottle recognition.

Next, still speaking of prescription drugs, be sure to find out if your patient is ‘compliant’ with their medications.  If a patient is not compliant, it means they are not taking their medications as frequently as they should, or in the right dose.  Ask them if they take their medications each day, and ask them how much they take (one or two pills, half a pill, etc.).  Then check the bottle to see if that’s the right dose.  You will need to know common pharmacological abbreviations to be able to do this (for example ‘once a day’ is OD, ‘twice a day’ is BID, etc.).  So do that, you can look them up on the internet or in most paramedic textbooks.

For the patient who has taken street drugs, you will also need to know which type of drug they took.  In order to understand their answer it’s good to know about the common street drugs that people take.  Know the drugs that are used in your area, and their common nicknames, and have an idea of what the different drugs do (even if it’s just what class of drug they are, i.e. stimulant, depressant, hallucinogenic, etc.)  Knowing the common drug dosages is helpful too, so you can know if they took too much (or too little to be of effect).  Just like I’m suggesting you develop your ‘bottle recognition’, I’ll suggest you learn about street drugs.  Keep a log and review it.

Sometimes I’ve had students who were embarrassed to ask patients if they’ve taken any street drugs, and I’ve also had patient’s get mad at me for asking them.  If either of these happens to you, remember ... it’s fair and it’s important than you ask.  You aren’t accusing anyone of anything, you care about them, and you want to know what might be wrong, so - as a medical professional - you need to ask.  It’s a part of your job, and it’s appropriate that you ask.  Say to your patient (or to yourself, if you’re embarrassed) “I’m not passing any judgement on you Sir (or Ma’am), but it’s important that I know about everything that might be going on inside of you if I’m going to help.  I’m not saying you DID take any street drugs, but if you did, it’s very important that I know, so I need to ask. It’s part of being a responsible paramedic, and it’s part of taking care of you as best as I can”.

Over-the-counter (OTC) drugs are a bit more tricky, because people don’t always realize that they are taking drugs.  I did a call for an elderly woman who had some bleeding problems.  We talked for a while and I noticed she really smelled like peppermint.  It didn’t ‘click’ at first, but then she said that she had ringing in her ears, as well as arthritis.  Aha!  I asked if she’d been using any cream for her arthritis and she said that she’d been using a ton.  When I looked at the cream, the active ingredient was ASA.  In fact, she was in ASA overdose (hence the ringing in her ears).  So always ask about creams, suppositories, puffers, pills or anything else they may have bought at the drug store (or whatever you call it in your part of the world). 

By the way, cigarettes count as OTC drugs, and they are important to know about.  If someone smokes, you should find out how many ‘pack-years’ they’ve smoked.  Smoking 2 packs a day, for ten years, equals 20 pack years.  One half a pack a day, for 30 years, is fifteen pack years.

Finally, just like we’ve done before, be sure to ask ‘anything else’?  Don’t assume that the first drug they mention is the only one they take.

Overview

I         Identify the Patient

C        Chief Complaint

I         Incident History

H        Past Medical HIstory

A        Allergies

D        Drugs

VS       Vital Signs

As.       Assessed   and

Tx       Treated