A Question I Ask Every Time
Before any operation, I ask patients to walk me through everything they take. Prescriptions, over-the-counter pills, vitamins, supplements, the occasional glass of wine with dinner. Almost every time, someone leaves something off the list. Not because they are hiding anything. They just do not think it counts.
That gap is the mistake I watch for most. Patients tell me about their blood pressure medication and their diabetes pills without hesitation. Then I ask about fish oil, or the turmeric capsules their sister recommended, or the daily aspirin they started years ago and forgot to mention, and I get a shrug. “That’s not really a medicine, though.”
It is. And it matters more than people think.
Why the Small Stuff Is Not Small
Fish oil and vitamin E thin the blood. So does ginkgo biloba. So does a baby aspirin taken out of habit. None of these show up on a standard medication list because people file them under “health” instead of “medicine.” But during surgery, anything that affects bleeding affects my plan.
The same goes for herbal supplements that interact with anesthesia. St. John’s wort changes how certain drugs metabolize. Some weight loss supplements raise heart rate and blood pressure in ways that complicate monitoring during a procedure. None of this is common knowledge, and none of it should need to be. It is my job to ask the right questions. But I can only act on what I am told.
What a Full Conversation Looks Like
A complete medication review is not a form you fill out once in a waiting room. It is a conversation, and it usually takes a few back-and-forth questions before the full picture shows up.
I will ask about prescriptions first, because those are the easiest to remember. Then I ask what else is in the medicine cabinet. Then I ask what a typical day looks like, because people often forget the coffee that counts as a stimulant or the nightly melatonin that counts as a sleep aid. By the third pass, something new almost always comes up.
This is not about catching anyone in an omission. It is about getting enough information to make a sound decision about timing, dosage adjustments, and what to hold before the day of surgery.
The Instructions Patients Skip
The other half of this mistake happens after the conversation is over. I give instructions about what to stop and when, usually a week or more before a procedure for certain blood thinners or supplements. Some patients stop everything on the list. Others stop the prescriptions and keep taking the supplements, because again, it does not register as medicine.
I have had patients walk into pre-op still taking daily fish oil because nobody told them to stop it specifically, even though “blood thinners” was on the list and fish oil is one. The instruction was clear. The category it fell under was not.
What I Do Differently Now
I stopped relying on the general category and started naming things directly. Instead of saying “stop blood thinners,” I list the common ones by name: aspirin, ibuprofen, fish oil, vitamin E, ginkgo. It takes longer to say, and it works better.
I also ask patients to bring the actual bottles to their pre-op visit, not a list written from memory. People remember prescriptions. They forget the supplement bottle in the kitchen cabinet that nobody thinks about until it is in front of them.
What This Means for You
If you have a procedure coming up, write down everything you take before your appointment, and I mean everything. Pills, powders, patches, the supplement a friend swore by, the occasional over-the-counter sleep aid. Bring it with you or bring the bottles themselves.
Do not decide ahead of time what counts and what does not. That decision is not yours to make alone, and it is not a judgment call that needs expertise. It only needs a complete answer to a simple question: what do you take, and when.
The patients who have the smoothest path through surgery are rarely the healthiest on paper. They are the ones who gave their surgical team the full picture before anyone made a plan.