A patient came to my Los Angeles office last spring carrying a gallon-sized plastic bag stuffed with pill bottles. Some were from her cardiologist. A few were from an urgent care visit she'd half-forgotten. Two were supplements her daughter swore by. She wasn't sure which ones she still took. Neither, frankly, was anyone else.
That bag is exactly why I do medication reconciliation with my patients. It's the unglamorous, careful work of sitting down and accounting for every single thing you put in your body, then checking that nothing on the list is fighting with anything else. It sounds simple. It prevents a startling number of problems.
What is medication reconciliation, and why does it matter?
Medication reconciliation is a structured review of all your medications to catch interactions, duplicates, and outdated prescriptions before they cause harm. I build one master list and compare it against what you're actually taking — not what a chart says you should be taking.
Those two things drift apart more than you'd think. A specialist adds something. A pharmacy switches a brand. A drug gets stopped at the hospital but the home bottle never gets tossed. Over months, the gap widens.
And here's the part people miss: I count everything. Prescriptions, yes. But also vitamins, herbal supplements, the occasional ibuprofen, the cousin's leftover antibiotic. Your body doesn't know the difference between "natural" and "pharmaceutical." It just reacts.
How do I know if I'm taking too many medications?
If you're on five or more medications, you're already in the range where interactions become more likely — a situation doctors call polypharmacy. It isn't necessarily wrong to take several drugs. Plenty of my patients managing high blood pressure and type 2 diabetes genuinely need each one.
The danger is when nobody is looking at the whole picture. One drug raises blood pressure while another lowers it. A supplement quietly thins your blood on top of an aspirin. A sleep aid stacks onto an anxiety medication and leaves you foggy at breakfast.
Watch for new dizziness, unusual fatigue, stomach trouble, or confusion that started around the time a prescription changed. Those are worth a conversation. Don't assume it's just age.
What should I bring to a medication review?
Bring everything — and I mean physically bring it, bottles and all, the way that patient with the gallon bag did. A typed list is good. The actual containers are better, because the labels tell me the dose, the prescriber, and the fill date.
It helps to include:
- Every prescription, even ones you take "only sometimes"
- Over-the-counter items like antacids, pain relievers, and allergy pills
- Vitamins, herbal products, and supplements
- Anything you stopped recently — and why you stopped
If you'd rather not haul a bag across town, a clear photo of each label works too. We can also do this over a telehealth visit with the bottles in front of you on the table.
How often should medications be reconciled?
At minimum, I review the list at every annual physical — but the moments that matter most are the transitions. After a hospital stay. When a specialist starts something new. When a dose changes.
Those handoffs are where mistakes hide. A patient leaves the hospital on a fresh medication, goes back to the old bottle of the same drug, and suddenly doubles the dose without realizing it. I see versions of this regularly, and almost all of it is preventable with one honest conversation.
For anyone with several ongoing conditions, I fold these reviews into their chronic disease management so the list never gets stale. Small, frequent check-ins beat one big cleanup a year.
The quiet payoff
Most of the time, a thorough review ends with good news. We trim a redundant pill. We catch a supplement nobody mentioned. We confirm the rest is working as intended, and you walk out lighter — sometimes literally.
That's the goal. Fewer surprises. Fewer drugs doing the same job twice. A list short enough that you can actually remember what's on it and why.
If your medications have piled up, or you're simply not sure anymore what you're taking, let's go through it together. Bring the bag. Reach out to my practice and we'll sort it out, one bottle at a time.