So, I had an interesting phone call today. A woman who isn’t a patient of ours called to ask about her eyes. She told me they were red, puffy, and almost swollen shut. I asked if both side were equally swollen, and she told me they were. She also told me the few medications she was on, but stated that she had been on them for a while. At this point, I had come to the conclusion that is was either really bad seasonal allergies or that she had consume or used something that she was allergic to without knowing it.
I asked if she had eaten anything out of the ordinary or new recently and if she had switched soaps or detergents in her house. She answered no. I started telling her that she should take some diphenhydramine and call her doctor first thing in the morning. She interrupted me, asking if there were any interactions with that and her other medications. I told her no, and she replied back to me: “Well, that’s good. I just wanted to make sure, since these medications are all sort of new to me.” Whoa. Back up. Rewind. Didn’t she just tell me she had been on them for a while? I asked her when she began taking the medications. She told me she started them a week ago. *facepalm*
So now, the tables have turned. Now, I’m leaning more towards a drug allergy being the cause of this. But, the question is, which one is causing the problem? She started each of them on the same day. I told her this and let her know the only way to know for sure which drug would be the cause is to discontinue all of them and restart each individually. Again, I told her to take the diphenhydramine and call the doctor first thing in the morning. I also told her if she experienced any throat tightening or trouble breathing to go to the emergency department of the nearest hospital. She agreed to do so if needed, thanked me, and hung up.
The take home point of this story is to always ask questions. Lots of questions. Ask the same thing in different ways. Use open-ended questions (when did you start these medications vs. have you been taking these medications for a while). It’s important for us to ask these questions and get to the root cause of why the patient is speaking with us. It’s how we screen them and determine what action needs to be taken next, whether it be self-treatment, a call to the doctor, or even a hospital visit. Never be afraid to ask the same thing again if you need to. When patients seek out your help and advice, they usually don’t mind the questions. Most times, they appreciate how much effort we put in to helping them. This is one of our duties to our patients. It falls under the “Do No Harm” portion of the Hippocratic and/or Pharmacist’s Oaths. And, it can make all the difference in a person’s life.
Image courtesy of http://i33.photobucket.com/albums/d76/xx_Emmeh_xx/eyeball.jpg