Joey Wahler (Host): It affects many people for a variety of reasons. So, we're discussing medication concerns. Our two guests from Southeast Georgia Health System, Brunswick Campus are Dr. Misty Leigh Williams, she's both a physician and Vice Chief of the Hospital Medical Staff, as well as Jennifer Boykin, who's a clinical pharmacist.

 This is Health Matters from Southeast Georgia Health System. Thanks so much for joining us. I'm Joey Wahler. Dr. Williams, Jennifer, hi. Welcome to both of you.

Jennifer Boykin, PharmD, BCPS: Hi.

Misty Leigh Williams, MD: Hi.

Host: Great to have you both aboard. So, first for you, Dr. Williams. What would you say first inspired your healthcare career and your particular area of expertise?

Misty Leigh Williams, MD: Well, I come from a family of teachers, so my grandmother, mother, sister, all teachers. But from a really young age, I was always the child who wanted to put on a bandaid or take out a splinter. And so, I knew that I wanted to go into Medicine. I am a hospitalist. I did Internal Medicine and Pediatrics, but really gravitated more towards adult hospital medicine. So, I just take care of patients here in the hospital.

Host: So, you've always been very focused about what you wanted to do from a very early point, huh?

Misty Leigh Williams, MD: Yes. Yes, I have.

Host: That's great. And what would you say first brought you to the area?

Misty Leigh Williams, MD: So, I was a hospitalist up in the DC Maryland area, and our hospitalist program there was starting the new practice here. We moved down here and had visited the area and really loved it. And so, I started the hospitalist program here now 16 years ago.

Host: Excellent. And Jennifer, why healthcare for you? Where did that interest start, and specifically pharmacy?

Jennifer Boykin, PharmD, BCPS: Well, actually, I always told everyone that I would not do healthcare because my mom was a nurse. And then, she said, "Never say never." And that's how I ended up as a pharmacy technician at the hospital in Savannah, and I really liked it. So, I pursued trying to get into pharmacy school and was successful.

Host: So, mom was right yet again, right?

Jennifer Boykin, PharmD, BCPS: Yep. Hard to say, but true. .

Host: You have to give it to her. And how did you wind up in the area?

Jennifer Boykin, PharmD, BCPS: Well, I was in the Savannah area from Savannah, and they had a job opening down here and it's turned into something that I really enjoy. I'm also a preceptor for South University, and I work in the ICU.

Host: Great to hear. So, let's get into this topic. It's an important one because it affects so many people as we mentioned at the start. Jennifer, what are some common questions patients typically have about their medications?

Jennifer Boykin, PharmD, BCPS: All kinds. Primarily, "How do I take this? What do I do if I miss a dose? Do I take it with or without food?" And most importantly, what can I expect from this medication?" which is something the patients are obviously very, very concerned about. I.

Host: Dr. Williams, why is it so important to take medications as prescribed and what can happen if you don't? Because there are those out there that are self-medicating as it's called, right?

Misty Leigh Williams, MD: Right. And so, all of the medications have been developed, and we have very specific treatment doses and durations and strengths. It's very important to take those medications as prescribed. And if you don't, then you can not get better, not respond to treatment. You can have side effects. We worry about drug resistance, especially with antibiotics. And then, if you're not taking your medicines and your healthcare team thinks you are, then that can cause some concern or confusion if you're not responding. And we think that the medication's not working, but really you're not taking it. So, it is important to take all of those as prescribed and to communicate with your healthcare team.

Host: Doctor, how can patients better understand why they're taking a specific med in the first place?

Misty Leigh Williams, MD: Once again, communication with your healthcare team is so important and asking those questions of your healthcare provider or of your pharmacist about: what is the medicine? What is it for? When do I take it? How do I take it? And then, you can always ask for a written list of medications. It's always helpful if you have a family or friend or caregiver who could go with you to an appointment to help take notes, and then back to asking questions if you don't understand something. It doesn't hurt to ask those questions and to make sure you understand.

Host: Speaking of which, Jennifer, those of us that go to the local pharmacy and see the pharmacists in action, we know that often they're bogged down answering a lot of questions. So, it begs the question, which ones should patients ask their doctor versus the ones they should ask a pharmacist like yourself?

Jennifer Boykin, PharmD, BCPS: So, the doctors are going to be able to best tell you what medication is for. Sometimes they have lots of different indications and what they're expecting to happen. So if you're taking a medicine for high blood pressure, it should help lower it. For the pharmacist, we would be able to tell them more about how it's going to make them feel, and how they're supposed to take it in general, all those other questions as well and storage and how to be safe with their medication.

Host: So, Doctor, what should someone do if they're afraid of or are in fact experiencing medication side effects?

Misty Leigh Williams, MD: That's always a good thing to talk about, because a lot of patients are concerned about side effects and it's good to be aware and to be prepared, talking to your provider about what to expect and what your concerns are so that if your physician knows kind of what your concerns are. Is it that you've had a bad experience, that a family member has had a bad experience? Is it just something that you've read online? Is it something you've read in the package insert? So that they know what you're worried about, and you all can have kind of an open line of communication. And then, to pay attention to those symptoms and always let your physician know if you are having issues and don't just wait until it becomes, you know, overwhelming or that you wait 'til late. We would rather know sooner rather than later if you are having issues.

Host: Gotcha. Jennifer, here's one that I'm curious about the answer to in particular, because I've often wondered this. What are the main differences between generic and brand name medications and how should patients approach those options?

Jennifer Boykin, PharmD, BCPS: Well, brand and generic are usually technically the same. When the FDA is approving a new drug and then generics, they give it an AB rating. So, A means they've determined that it is essentially the same. B means it may not be. So, there are some situations you don't want to switch like that, so like seizure medications and heart rhythm medications and thyroid medications. You don't want to do that quickly. And you want to talk to your doctor to transition so you can be appropriately monitored. But for the most part, it's almost like you're at the grocery store, and you've got the store ketchup and you've got the Heinz ketchup. And it's going to be the same thing, they're probably made at the same plant, and then put in different bottles.

Host: Understood. And Jennifer, how about the differences in psychiatric medications that people should be aware of?

Jennifer Boykin, PharmD, BCPS: Our most important counseling point for psychiatric medications and things for mood disorders is that you may not see effects of the medication and as in improving your symptoms for weeks. So, it's very important to understand that you might get side effects before you get beneficial effects from the medication. That can be really discouraging and upsetting for patients. Obviously, having those worse feelings is difficult. So, we want to make sure we counsel them that if they start experiencing worsening symptoms, their depression or anxiety, that they have someone to talk to, they can monitor it. And if they have thoughts of self-harm or suicide, it's very important to call the suicide hotline, which is 988 at any point in time 24/7. You can reach out and get help that way, or you can present yourself to the hospital or call your doctor.

Host: And Jennifer, that's an important point you made about how those drugs take time to kick in. It takes time for some side effects to either go away or to ease up as well, if I'm not mistaken. So, patience is important and being aware that that's going to be the case, and it's not just going to be a quick fix, right?

Jennifer Boykin, PharmD, BCPS: That's correct. It does sometimes take weeks and weeks to see an effect.

Host: No question. Dr. Williams, sticking on that topic, how can depression or anxiety in and of itself impact the patient's willingness to take medications? It takes not just that patience that Jennifer and I just touched on, but the right mindset. And sometimes people that need these drugs don't have the right mindset to begin with. So, that's a challenge, isn't it?

Misty Leigh Williams, MD: Right. It definitely is a challenge and difficult because some of the symptoms that you may have with depression or anxiety affect your ability to take those medications. So, depression can sometimes affect memory and concentration, which limits your ability to take your medicine. Sometimes you feel hopeless. So, think, you know, "I don't want to take the medicine anyway." It can cause like fatigue, lack of motivation, all of those things. So, you really need the medicine, but what you're needing it for, the mood disorder, affects your ability to take that. And so, that's why it's really important as providers that we have that empathetic conversation with patients, really work with them about understanding taking their medicines, and then working with other mental healthcare providers to assist with that if they need it.

Host: Absolutely. And Jennifer, how about stopping a psychiatric medication? How does that differ from stopping other meds? Because you really need to wean off it as opposed to just stopping cold turkey or that can cause other problems, right?

Jennifer Boykin, PharmD, BCPS: That's absolutely correct. So if you've been on medications for a period of time, weeks, perhaps months, maybe even years, your brain has gotten used to the change in the chemicals that that drug was providing. So if you stop it suddenly you may have terrible side effects, anxiety, insomnia, return of course of your problems to begin with the depression, things like that. So most doctors, that needs to be a good conversation with them about how to slowly change the medication over, and sometimes they take weeks as well to take off the medication.

Host: So yet another thing for people to keep in mind when they're getting started on, or you know, are in the process of taking such a drug. Couple of other things. Jennifer, you mentioned that there's a suicide and crisis hotline. The phone number is simple enough, 988. Maybe give people a better idea of what that's for exactly.

Jennifer Boykin, PharmD, BCPS: That is for anyone who is experiencing any thoughts of suicide or thinking of self-harm or anything else. I hate to say homicidal as well, but that sometimes happens as well. If they're thinking of hurting themselves or somebody else, there's another person on the end of that line that is especially trained to be able to talk to you and try and help you get the help you need.

Host: And then, in summary, I want to ask you both this because it's so important, and I happen to have seen on a TV program I'm watching, an episode that happened to address this. It's a drama, it's not real life, but it's a real-life problem that they were addressing, and that's managing multiple prescriptions. There are so many people, as the two of you know better than anyone, that take a variety of drugs for a wide variety of ailments. So first for you, Dr. Williams. What's the safest way to navigate taking several prescriptions at once?

Misty Leigh Williams, MD: One of the most important things is to always, if you're able, use the same pharmacy so they have one central list of your medications and they would be aware of any interactions or issues if you get prescribed a new medication. And then, you as the patient should have your own list. That's very important to keep your own list of medications and to take that with you with every physician visit or provider visit so they can go over those.

And then, we always encourage patients to have a medication review with your primary care provider and your pharmacist at least once a year to go over all of your medicines, make sure everyone is aware of what those medicines are. And then, using pill boxes, pill reminders, reminder apps if you are on multiple medications, to just make sure you're taking them in the safest way possible.

Host: And speaking of which, Jennifer, in addition to what the doctor just mentioned, how can patients taking multiple medications make sure that someone's minding the store here, as they say, that someone knows everything you're taking and therefore is aware that if you add something or if you take something away, it's not going to cause a big uproar overall in whatever's going on with you, right?

Jennifer Boykin, PharmD, BCPS: Yes. So for instance, that medication list we talked about, limiting it to one pharmacy, if at all possible. And having someone maybe helping you, especially people that are getting older and have a lot to manage, second set of ears is always very helpful. So if you have medications that you get started or stopped, especially if you just got outta the hospital, you would probably like to go home and separate those medications out that you already have at your house. Keep them separate. You don't have to get rid of them if you think you might restart them, but you of course can dispose of them properly at any pharmacy.

You also want to make sure if you're on automatic refills at your pharmacy and they're filling it month to month or every three months without you having to ask for it, that you tell them that that medication has been stopped. And make sure you check what you're picking up so you're not paying for something you don't need, or accidentally taking home something that's going to do the same as something else in your drug cabinet.

Host: Well, again, as we mentioned at the top, I think it's a topic that doesn't get enough attention or discussion considering how many people it affects. Folks, indeed we trust you are now more familiar with medication concerns and management. Dr. Williams, Jennifer, keep up all your great work. Continuing to help patients keep it all straight, right? And thanks so much again.

Jennifer Boykin, PharmD, BCPS: Thank you.

 Thank you.

Host: Absolutely. And for more information, please do visit sgs.org/providers. If you found this podcast helpful, please share it on your social media. And thanks again for being part of Health Matters from Southeast Georgia Health System.