Patient comes into clinic. Has a medication list (AMAZING). Is on a mess of medications. A mess. Three pills for the same problem, nothing for another problem, two that interact, at least three he shouldn't be on, a couple that should be replaced with better alternatives. So I talk to my attending and we decide to clean up the med list, get him on the right set of pills... and he asks the very legitimate question: WHY SO MANY CHANGES?
And the very legitimate follow-up-- "Did my last doctor screw up?"
Now, fortunately, there doesn't seem to be anything bad that happened because of the less-than-optimal medication regimen. So, fortunately, his questioning is more out of curiosity than any real demand for answers.
It's true that I don't even know if I have an answer for him. I don't know if he's taking the medications he was told to take, and only the ones he was told to take. I don't know if he brought his full med list to his last visit. I don't know if he's still ordering refills on things he should have stopped, until the refills on the prescriptions run out. I don't know if he might have described different symptoms in the past. I don't know if other doctors know more than I do or have had different experiences with different medications.
But I do have a strong feeling that, yes, someone probably screwed up, or at least failed to think about the full medication list. So do you tell that to the patient, or do you glide past the question, and decide that since you don't know for sure, and there don't seem to be any repercussions, the more responsible thing to do is to not throw another doctor under the bus?