Med Wreck: Overcoming Medication Reconciliation

Med Wreck:  Proposing a Solution for the Nightmare of Medication Reconciliation

Medication reconciliation (“Med Rec”), or “Med Wreck” as many now call it, has been a topic in the industry for over a decade. Some people believe it began as a major patient safety initiative. It is related to the universal observation that transitions of care are the most dangerous times in healthcare.  Although we have made progress as an industry in the past five years with Med Rec improving patient care, it has its problems.

It may be that this book is your introduction to Med Rec. If so, this book is intended to give you a good definition and a little history of how this came about. 

Many physicians today see Med Rec (or “Med Wreck”, as it is often called) as the proverbial millstone around their necks.  Their responses to it vary, but fall into one of the falling categories:

·       They don’t want to do it. 

·       They want someone else to do it.

·       They go through the motions to check that they did it, even when they don’t think it is accurate.

But why is that? Isn’t Med Rec a process to make healthcare transitions safer? If so, why are doctors reluctant to do it? Doesn’t it seem logical and obvious that they need to do it and do it well? Why do many in the industry call Med Rec “Med Wreck”?

This book is intended to address those questions and to propose a solution. It will address the history of Med Rec, the current state of Med Rec, and the planned future of Med Rec.  However, this book is also about a possible different future than that to which we are currently headed.  A future without Med Rec as we know it today.  Or more precisely, a future without “Med Wreck.” 

We hope you will download and read this free e-Book and share it with your doctors, your family and your friends.  In the meantime, also download the Patient Medication List template.  Use it to record your current medications and carry it with you at all times.  Medication management is important.  Let’s all take the danger out of the process.  We hope to make Med Wreck a national conversation and a call for reform.

Haven’t yet got your copy of Med Wreck?

Download the free e-Book

In this free e-Book, Dr. Phil Smith discusses the process of medication reconciliation and why it is not the final solution for preventing medication errors and harm. He refers to the current state as Med Wreck. He proposes a national movement – creating a new solution to protect Americans from a broken system.

Cover of Med Wreck ebook
Med Wreck ebook

The Med Wreck book is now offered exclusively at still as a free download.

Also, we encourage you to download our free Patient Medication List template for yourself and your loved ones.

Supplemental Material for…

Med Wrxeck:  Proposing a Solution for the Nightmare of Medication Reconciliation

Med Wreck reviews the current state of medication reconciliation and proposes a solution for transforming it. Yes, there is a path for overcoming medication reconciliation (Med Rec).  This page presents diagrams, figures and supplemental information from the eBook.  Please feel free to share the eBook with others who may be interested in the topic.  We welcome your feedback below.

Logo for Med Wreck Book on Medication Reconciliation

The diagrams from Med Wreck below may be downloaded and enlarged to see improved detail.  If you use them, please properly attribute them since the materials are copyrighted. Clicking on each diagram will open it in a “lightbox” window for enhanced viewing.


Bar Graphs showing distribution of chronic conditions of Americans over age 65.

Figure 2. Distribution of chronic conditions among Medicare recipients by age.

Number of Chronic Conditions by Age Group

Figure 2-1 (Page 11): A growing number of Americans (133 million in 2012 or 40% of the population ) have one or more chronic conditions /illnesses and are likely taking one or more daily meds. Patients on multiple meds don’t always know the names of the medications that they are taking. Moreover, they may not know the details on dose/frequency of each medication. Additionally, a patient’s likelihood and number of chronic diseases increases with age as CMS reports.  See bar graphs of number of chronic diseases by age groups.

Bar graph showing percent of patients having 2 or more chronic conditions by age group.

Figure 3. Most Medicare recipients have two or more chronic conditions.

Number of Individuals with two or more Chronic Conditions by Age Group

Figure 2-2 (Page 12): As Medicare patients age, the percentage with 2 or more chronic conditions increases as well.  Note that in the youngest Medicare age group (65 – 74 years) 63% have 2 or more chronic conditions.

A modified cause-and-effect (fish bone) diagram demonstrating over two dozen factors contributing to provider dissatisfaction with medication reconciliation.

Figure 4: Physician Dissatisfaction with Medication Reconciliation

Physician Dissatisfaction with Medication Reconciliation

Figure 2-3 (Page 24): This diagram from 2010 was the first attempt by the author to understand the many reasons that providers were frustrated and dissatisfied with medication reconciliation.  Many of the factors were related to the lack of an accurate medication history.

(First published in Smith PA (2013) Making Computerized Provider Order Entry Work. Springer, London.)

Modified Cause-and-Effect (Fish bone) Diagram showing the many Challenges of Medication Reconciliation (Med Wreck)

Figure 5. Modified Cause-and-Effect Diagram of Med Rec Challenges

The Many Challenges of Medication Reconciliation (Med Wreck)

Figure 2-4 (Page 26)  This diagram demonstrates the many factors that contribute to Med Wreck (the many challenges of medication reconciliation in 2017).