Wesley Lisker - President
Wesley Lisker has been a practicing internist and nephrologist for 30 years. For most of this time, he has also been closely involved in the areas of hospital quality and safety, physician quality, disease management and quality improvement. He graduated with a BA in neurobiology, a multidisciplinary major, from Berkeley in 1975, and with a MD from St Louis University in 1979. He completed his internship and residency in internal medicine at Jewish Hospital of St Louis, Kaiser Foundation Hospital, Oakland, CA, and Santa Clara Valley Medical Center in San Jose, CA. He received his nephrology fellowship from Stanford University.
As a practicing nephrologist and internist, he has personally cared for several thousand patients with chronic renal failure, kidney dialysis and organ transplants. Many of these patients are on complex medication regimens, often exceeding 10 different daily medicines taken in multiple numbers. He has had a deep interest in epidemiology, population health, performance improvement, quality and safety, and for nearly two decades served as the chief of quality for his medical center which cares for over 250,000 individuals in northern California. He currently has an administrative role in his medical group's hospital quality and safety efforts, and has been involved with, initiated or managed quality improvement efforts ranging from reducing mortality in certain disease entities, to hiring the first case manager in end stage renal disease and helping initiate a peritoneal dialysis program for the medical center. In addition, he has maintained a medicine practice of mostly elderly adults, continues his sub-specialty work in kidney diseases and dialysis, and attends at two dialysis clinics.
While great strides have been to eliminate medication errors in the hospital setting, he is delighted to be able to contribute to the development of this program which focuses on patients at home. The Foundation's patient-centered program has already helped his own patients manage their medicines better. He hopes it will address the potentially dangerous confusion over medications which exists among patients, especially low-literacy ones, their family and caregivers in the community by helping them track their medication regimen and communicate its changes more effectively with their physicians, care-managers and other professionals.
He thinks it could be helpful to learn why he wanted to form this Foundation if you read a story about one of his patients who had trouble with their medicines. It's an example of how a smart man with high blood pressure got sick because he confused his meds due to low literacy.
This is about "Glen." Years before Lisker met him, Glen was diagnosed with high blood pressure and put on one medicine. He could barely read and pronounce its name, but one pill wasn’t a problem... Then he got put on another pill... And another... And over a few years, he had a box of full of medicines with names he couldn’t pronounce. Then he had a problem.
When Glen saw his doctors, and was asked what medicines he was taking, he would thunder, "Doc, I’m on the blue pill and the red pill and the white one. And, Doc, don't YOU know what I'm taking?? You and all the other doctors PRESCRIBE the damn things!!" And though the doctor knew there are hundreds of pills with similar colors, she had a pretty good idea from her own notes what Glen was taking. But she didn't realize Glen couldn't read well. And since Glen saw a lot of doctors, the other doctors didn't know what was being prescribed. So, once the doctors and Glen came to some agreement about what he was supposed to be taking, prescriptions would be changed, added or stopped. At the end of the appointment, Leonard would agree, "Sure, Doc," and go to the pharmacy where he'd get some counseling he couldn't understand, and more bottles with labels he couldn't read.
You can guess what happened next. Glen confused them...and he got very, very sick. But the hospital doctors didn't really know why he was sick, because, when he was hospitalized several times, put on the correct medications and tuned up, he got better. The doctors figured all was good, and he was just a sick, sick guy. But, after the last hospitalization, Glen figured out what really happened....he screwed up his medicines because, as he told a doctor much later, he couldn’t read.
He was embarrassed to admit it: he couldn't read well enough to help himself. He was actually a very intelligent man. So, when Glen got home, he knew he had to do something. He decided to label his bottles with something he did know: the Alphabet. When he got the first pill he labelled its bottle lid with an “A,” and the second one a “B,” and so on. By the time Dr Lisker got to see him, he was deep in the alphabet. However even though HE knew his pills, the doctor didn’t know Glen's code. Glen still called his pills by their colors, and demanded to know why the doctor didn’t know what he was taking!
Glen’s kidneys eventually failed due to high blood pressure, and the doctor took care of him for years on dialysis. Later, he developed a terminal phase, and entered hospice. His home was on the doctor's route, so he dropped in to visit a few times while Glen was dying. That’s when he saw Glen's box of pills with the letters on them. Glen had never brought them into the office. The doctor thought, what an interesting if unique system! Since the doctor couldn't understand why the bottle caps were labelled with letters unrelated to the pills name or some other medicine characteristic, he asked Glen to explain his system. Only then did the doctor learn that Glen couldn't read. While the doctor admired Glen's solution, he had no idea, over the hundreds of prescriptions and many years, what Glen was doing to keep out of trouble.
Maybe if Glen had been able to take his medicines as prescribed his kidneys wouldn't have been hurt so badly.
Glen's trouble with pills is not an isolated problem. It’s rampant. Some of the systems developed to help reduce this kind of medicine confusion work better than others, but none of them have pictures of the actual pills, calendars that are flexible and easy to manipulate, and are accessible to the many people who interact with and help patients. The Medication Safety Foundation has created a system that puts the patients at the center in a way that gives them control, or lets them delegate that control to their family, doctors, nurses or care managers--whomever is in best position to help them stay as healthy as possible. The Foundation knows it must address the problem from the patients' point of view and capacity which is why it includes pictures of the actual pills, whether white, yellow, green, pink or blue!
Lots of people have recognized that a major reason patients get sick is because their disease gets out of control due to adherence problems. The Foundation's ideas result from observations and experience, review of the literature on the topic, work of the doctors, and their observations of dedicated case managers and nurses who help patients in their homes, as well as by conversations with families and patients. There are solutions to this risky problem, and the Foundation has come up with some really good ideas like the medication calendar, which can make a difference in the lives of a lot of people and their families.
