Medication management across multiple doctors — preventing the silo problem

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your parent sees a cardiologist for heart disease, a nephrologist for kidney problems, a rheumatologist for arthritis, and a primary care doctor for everything else. Each specialist is excellent in their field. Each knows their part of your parent's medical picture. But they're working in separate silos, often not communicating with each other. The cardiologist prescribes a medication for heart rhythm. The nephrologist doesn't know about it. The rheumatologist prescribes something for inflammation. The cardiologist doesn't know about it. Your parent is the only connection between these specialists, and your parent's cognitive or physical limitations mean that connection isn't reliable.

This fragmentation leads to duplicate medications, dangerous interactions, and medications that work against each other. Your parent ends up taking more medications than necessary because nobody is looking at the whole picture. Your parent's kidney function worsens because a medication that seemed fine to one specialist is harmful to someone with kidney disease. Your parent's blood pressure medication fights with another medication they're taking. These aren't rare problems. They're common consequences of siloed medicine.

You're the person who can prevent this. You're the coordinator who sees the full picture. You carry information between doctors. You spot problems before they become dangerous. You make sure that every medication your parent takes is coordinated and necessary. This coordination role might be the most important thing you do for your parent's health.

Understanding the Silo Problem

The silo problem happens because modern medicine is specialized. A cardiologist specializes in hearts. They know heart medications inside and out. A rheumatologist specializes in joint disease. They know anti-inflammatory medications intimately. But each specialist typically only sees the part of your parent related to their specialty.

Your parent shows up to see the cardiologist with symptoms of arthritis. The cardiologist says, "Your heart is stable. Come back in six months." The cardiologist doesn't know about the severe arthritis because it's not their specialty. The rheumatologist sees your parent for arthritis and prescribes an anti-inflammatory medication. The rheumatologist doesn't know that this medication can affect kidney function or blood pressure. Each specialist makes good decisions within their domain. But those decisions might not be good when you consider your parent's entire medical picture.

Your parent's primary care doctor should theoretically coordinate everything. But primary care doctors are overworked. They see thirty patients a day. They don't have time to review every medication and check for interactions. They might not know that your parent started a new medication at a specialist's visit unless you tell them. The coordination that should happen often doesn't.

This is where you come in. You become the coordinator. You know what medications your parent is on because you picked them up from the pharmacy or helped fill the pill organizer. You see the specialist appointments because you drove your parent or got the after-visit summaries. You can spot when something doesn't fit the bigger picture. You can ask questions that specialists might not ask.

Building Your Coordination System

Start by creating a comprehensive medication list. This list includes every medication your parent takes, including over-the-counter medications and supplements. Include dosages and what each medication is for. Write down the doctor who prescribed each medication. Include the pharmacy phone number and your parent's medication allergies.

This list is your reference document. When your parent sees a new specialist, bring this list. When you pick up a new prescription, update the list. When a medication is stopped, cross it off. When doses change, update the dose. Keep this list current and accessible.

Give a copy to each of your parent's doctors. Some doctors will file it. Some will ignore it. But you've created a record that you prescribed a complete medication list. If something bad happens, everyone will know you tried to ensure coordination.

Being Present at Doctor Appointments

When your parent sees a specialist, try to attend the appointment. You're there to listen and remember. You're there to ask questions. You're there to make sure the specialist knows about your parent's other conditions and medications.

Before the appointment, tell the specialist about your parent's complete medication list and chronic conditions. Say something like, "Mom also takes a blood pressure medication and has kidney disease. Are there any concerns about interactions with what you're prescribing?" This question prompts the specialist to think about your parent's whole situation, not just the one condition they're treating.

After the appointment, get a copy of the visit notes. Many clinics now give these to patients automatically. These notes tell you what the doctor found, what they diagnosed, and what they're prescribing. Having these notes means you have records of what every specialist is doing.

Asking the Right Questions

When your parent gets a new medication, ask the doctor specific questions. "Why are we using this particular medication instead of a different one? Are there interactions with my parent's other medications? How will this medication affect my parent's kidney function? When should this medication help my parent feel or function better?" These questions prompt the doctor to think carefully about the prescription.

If you notice that a medication prescribed by specialist A might interact with something prescribed by specialist B, ask about it. Say to the primary care doctor, "The rheumatologist started Dad on this anti-inflammatory medication, and I'm concerned about how it might affect his kidney function. The nephrologist said his kidney function is already declining. Is this medication safe?" This question flags a potential problem.

If you see that medications seem to work against each other, say something. "Mom's taking a diuretic for heart failure, but she also has low blood pressure. These seem to be working against each other. Is there something that could be adjusted?" These questions make doctors think about whether everything in your parent's medication list is truly necessary and coordinated.

When Specialists Don't Know About Each Other

Sometimes specialists literally don't know about each other. Your parent hasn't mentioned the rheumatology visit to the cardiologist. The cardiologist's office didn't send records to the primary care doctor. Your parent kept the information to themselves because they didn't think it was relevant.

You solve this by explicitly telling each doctor about your parent's other care. Tell the cardiologist, "Mom sees a rheumatologist who just prescribed a new anti-inflammatory medication. I want to make sure there are no interactions with her heart medications." This conversation is awkward but necessary.

Ask the cardiologist to request records from the rheumatologist. Ask the primary care doctor to coordinate between specialists. Some doctors will welcome this coordination. Others will resist. Persistence matters. You're not being pushy. You're preventing dangerous problems.

Using Your Parent's Pharmacy As a Safety Net

Your parent's pharmacy is another coordination point. A good pharmacist watches for dangerous interactions. They know all your parent's medications because they fill them. They can spot when a new medication might interact with something your parent is already taking.

Tell the pharmacist about your parent's conditions, especially conditions like kidney disease or liver disease that affect how medications are processed. Say, "My parent has kidney disease. I want to make sure all medications are safe for kidney disease." The pharmacist will check. If a medication isn't appropriate, they'll flag it.

Build a relationship with your parent's pharmacist. They're a valuable ally in medication coordination. If you have questions about medications, ask the pharmacist. They can often answer questions faster than doctors can and without appointment delays.

When Deprescribing Reveals Silo Problems

Sometimes the first time you try to deprescribe a medication, you discover that multiple specialists prescribed similar medications. Your parent is on two blood pressure medications when maybe they only need one. Your parent is on two anti-inflammatory medications when one might suffice. Multiple specialists didn't know about each other's prescriptions.

This is a deprescribing opportunity. Work with the primary care doctor to identify which medications are truly necessary. Often you can eliminate redundancy and simplify your parent's medication list.

Creating a Summary That Travels With Your Parent

Create a one-page document that summarizes your parent's key medical information. Include diagnoses, current medications, allergies, and primary care doctor contact information. Print multiple copies. Give one to each of your parent's doctors. Keep one in your parent's wallet. Put one on the refrigerator. Have your parent carry one when traveling.

This document is quick reference that any healthcare provider can review. If your parent ends up in an emergency room, the ER doctor can quickly understand their medical situation. If your parent sees a new specialist, that specialist knows their background. This simple document prevents many problems.

Being Respectful But Firm

You're asking doctors to think about your parent's whole situation. Some doctors will enthusiastically embrace this. Others will seem dismissive or resistant. They might say, "I don't have time to review that. That's the primary care doctor's job." Or "I only treat [specialty]. Other doctors can manage other issues."

Stay respectful but firm. Say, "I understand you specialize in cardiology. But my parent is on many medications and I want to make sure we're preventing interactions. It will only take a moment to check the medication list." Most doctors will take that moment. Some won't. If a doctor is truly unwilling to coordinate, consider finding a different doctor.

Your parent's health and safety matter more than one doctor's preferences. If a doctor won't coordinate, you might need to work with the primary care doctor to insist on coordination, or you might need to find providers who communicate better.

Your Invaluable Role

You're doing work that the healthcare system doesn't adequately support. You're serving as coordinator, translator, and safety monitor. You're remembering what each specialist said. You're asking questions that doctors might not ask. You're preventing dangerous situations. This work is exhausting and often unappreciated, but it's absolutely essential.

Take a moment to acknowledge that you're doing important work. Your attention to detail, your willingness to ask questions, and your commitment to seeing your parent's whole picture make your parent safer. That matters immensely.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. Medication coordination should involve all of your elder's healthcare providers and ideally be supported by a primary care physician who understands your elder's complete medical situation.