The brown bag check-up: How one simple habit can prevent medicine mistakes
A brown bag consultation is simple, inexpensive, and powerful. It negates the effects of polypharmacy and reduces pill burden, prevents harm, cuts unnecessary expenses, and empowers patients to take control of their health.
A few months ago, a 63-year-old woman walked into my consultation room carrying a thick folder with three separate prescriptions from three specialists, an endocrinologist for diabetes and lipid-related issues, a cardiologist for her past heart problems, and a neurologist for numbness and tingling in her feet.
Each doctor had examined her, reviewed her reports, and written a prescription. Each prescription was well thought out; however, the problem was that the three prescriptions had never been viewed together.
When I placed them side by side on my table, a familiar pattern emerged. There were medicines for diabetes, cholesterol, blood pressure, blood thinning, acidity, nerve pain, sleep, vitamins, calcium, “neurotonics”, liver support tablets, and a few supplements described as “for strength” and “general health”. Some medicines overlapped. Some were being continued long after their original purpose had passed. Some supplements were being taken because they had appeared on one prescription and then quietly survived across the next several visits.
She added, “Doctor, I am afraid to stop anything because all of these have been written by doctors.”
This is the everyday face of polypharmacy.
Polypharmacy is a situation in which a patient is taking five or more medicines. However, the real issue is not just the number of medicines. A person may genuinely need several medicines, and multiple drugs can be lifesaving.
The problem begins when medicines accumulate without periodic review, when one doctor does not know what another doctor has prescribed, when a tablet started for a temporary problem becomes permanent, or when supplements and tonics quietly add to the pill burden.
In India, polypharmacy is becoming increasingly common, especially among older adults. As people live longer with multiple chronic conditions, they often see several specialists. In a fragmented health system, each consultation may add one or two medicines.
The harms are not trivial. Multiple medicines increase the risk of side effects, drug interactions, dizziness, falls, acidity, constipation, kidney injury, low blood sugar, low blood pressure, confusion, and poor adherence.
A patient who has to take twelve pills a day may miss the most important ones simply because the schedule is too complicated. Some people take one medicine to treat the side effect of another. For example, a vitamin may be prescribed for weakness, but the weakness may actually be due to poor sleep, low mood, or overtreatment.
There is also a financial cost. In many Indian households, medicines are a recurring monthly expense. A prescription that looks affordable on one visit becomes costly when repeated month after month. Add supplements, and the monthly bill rises sharply. Ironically, the same patient may hesitate to spend on walking shoes, better food, eye check-ups, or follow-up consultations, while continuing to buy unnecessary pills.
THE POWER OF THE BROWN BAG REVIEW
When I saw this 63-year-old woman, I did remove a few pills during the first visit. However, for many brand names and supplements, prescriptions do not provide information on the exact composition. Therefore, for the follow-up visit, I requested her to return with three things: the most recent prescriptions from all three doctors, all recent investigation reports, and every medicine, strip, bottle, capsule, powder, and supplement she was actually consuming.
“Please put everything in one bag and bring it,” I told her.
She returned with a cloth bag full of medicines. This is what is known as a “brown bag” review or brown bag consultation in medicine. The idea is simple but is becoming increasingly popular.
The patient brings all the medicines being taken at home in one bag. The doctor then checks every item: what it is, why it was started, who prescribed it, whether it is still needed, whether the dose is correct, whether there is duplication, whether it interacts with another medicine, and whether the patient is actually taking it as advised.
The brown bag approach often reveals what a prescription alone cannot. Patients may continue medicines that are no longer on the latest prescription. They may take old antibiotics “when needed”.
They may take two brands of the same drug, not realising that both contain the same molecule. They may be taking supplements recommended by friends, pharmacists, advertisements, wellness influencers, or previous doctors. Some may take medicines irregularly but supplements religiously.
In this patient’s case, I first separated the contents into two groups. On one side, I placed prescription medicines: drugs for diabetes, heart protection, blood thinning, cholesterol, blood pressure, and nerve pain. On the other side, I placed supplements: vitamins, minerals, tonics, calcium, liver support tablets, and general wellness products.
I explained to her and her son, who was accompanying her, that all pills are not equal. Some medicines are required for the long term. Some are useful for a limited time. Some are optional. Some are unnecessary. Some are only adding cost and confusion.
Then came the process of deprescribing.
Deprescribing does not mean stopping medicines carelessly. It is a structured medical decision to reduce, withdraw, substitute, or simplify medicines when the harms, costs, duplication, or lack of benefit outweigh their usefulness.
It must be done thoughtfully, especially in patients with heart disease, diabetes, epilepsy, psychiatric illness, those taking blood thinners, steroids, sleeping pills, or long-term pain medicines. Some medicines can be stopped immediately; others need tapering. Some must not be stopped without specialist input.
WHY LESS CAN SOMETIMES BE MORE
By the end of the consultation, this patient’s prescription drugs had been reduced by almost half. Among the supplements, all except two were discontinued. More importantly, the patient finally understood her prescription. She knew which medicines were essential, which were temporary, and which had been removed.
This is the real value of a deprescribing consultation. It does not merely reduce the number of pills; it restores clarity. It tells the patient that more medicines do not always mean better care. It reminds doctors that our responsibility is not only to prescribe, but also to review, simplify, and deprescribe when appropriate.
Every patient with multiple chronic diseases should periodically ask for a medicine review. Every family should maintain an updated list of medicines. Every doctor should ask, “What are you actually taking?”
A brown bag consultation is simple, inexpensive, and powerful. It can reduce pill burden, prevent harm, cut unnecessary expenses, and empower patients to take control of their health.
In modern medicine, wisdom does not lie in adding one more pill at every visit. Sometimes, the most healing prescription is the one that safely removes what is no longer needed.
(Dr. Chandrakant Lahariya is a specialist in preventive and cardiometabolic medicine and an internationally certified metabolic health coach, based in New Delhi)
A few months ago, a 63-year-old woman walked into my consultation room carrying a thick folder with three separate prescriptions from three specialists, an endocrinologist for diabetes and lipid-related issues, a cardiologist for her past heart problems, and a neurologist for numbness and tingling in her feet.
Each doctor had examined her, reviewed her reports, and written a prescription. Each prescription was well thought out; however, the problem was that the three prescriptions had never been viewed together.
When I placed them side by side on my table, a familiar pattern emerged. There were medicines for diabetes, cholesterol, blood pressure, blood thinning, acidity, nerve pain, sleep, vitamins, calcium, “neurotonics”, liver support tablets, and a few supplements described as “for strength” and “general health”. Some medicines overlapped. Some were being continued long after their original purpose had passed. Some supplements were being taken because they had appeared on one prescription and then quietly survived across the next several visits.
She added, “Doctor, I am afraid to stop anything because all of these have been written by doctors.”
This is the everyday face of polypharmacy.
Polypharmacy is a situation in which a patient is taking five or more medicines. However, the real issue is not just the number of medicines. A person may genuinely need several medicines, and multiple drugs can be lifesaving.
The problem begins when medicines accumulate without periodic review, when one doctor does not know what another doctor has prescribed, when a tablet started for a temporary problem becomes permanent, or when supplements and tonics quietly add to the pill burden.
In India, polypharmacy is becoming increasingly common, especially among older adults. As people live longer with multiple chronic conditions, they often see several specialists. In a fragmented health system, each consultation may add one or two medicines.
The harms are not trivial. Multiple medicines increase the risk of side effects, drug interactions, dizziness, falls, acidity, constipation, kidney injury, low blood sugar, low blood pressure, confusion, and poor adherence.
A patient who has to take twelve pills a day may miss the most important ones simply because the schedule is too complicated. Some people take one medicine to treat the side effect of another. For example, a vitamin may be prescribed for weakness, but the weakness may actually be due to poor sleep, low mood, or overtreatment.
There is also a financial cost. In many Indian households, medicines are a recurring monthly expense. A prescription that looks affordable on one visit becomes costly when repeated month after month. Add supplements, and the monthly bill rises sharply. Ironically, the same patient may hesitate to spend on walking shoes, better food, eye check-ups, or follow-up consultations, while continuing to buy unnecessary pills.
THE POWER OF THE BROWN BAG REVIEW
When I saw this 63-year-old woman, I did remove a few pills during the first visit. However, for many brand names and supplements, prescriptions do not provide information on the exact composition. Therefore, for the follow-up visit, I requested her to return with three things: the most recent prescriptions from all three doctors, all recent investigation reports, and every medicine, strip, bottle, capsule, powder, and supplement she was actually consuming.
“Please put everything in one bag and bring it,” I told her.
She returned with a cloth bag full of medicines. This is what is known as a “brown bag” review or brown bag consultation in medicine. The idea is simple but is becoming increasingly popular.
The patient brings all the medicines being taken at home in one bag. The doctor then checks every item: what it is, why it was started, who prescribed it, whether it is still needed, whether the dose is correct, whether there is duplication, whether it interacts with another medicine, and whether the patient is actually taking it as advised.
The brown bag approach often reveals what a prescription alone cannot. Patients may continue medicines that are no longer on the latest prescription. They may take old antibiotics “when needed”.
They may take two brands of the same drug, not realising that both contain the same molecule. They may be taking supplements recommended by friends, pharmacists, advertisements, wellness influencers, or previous doctors. Some may take medicines irregularly but supplements religiously.
In this patient’s case, I first separated the contents into two groups. On one side, I placed prescription medicines: drugs for diabetes, heart protection, blood thinning, cholesterol, blood pressure, and nerve pain. On the other side, I placed supplements: vitamins, minerals, tonics, calcium, liver support tablets, and general wellness products.
I explained to her and her son, who was accompanying her, that all pills are not equal. Some medicines are required for the long term. Some are useful for a limited time. Some are optional. Some are unnecessary. Some are only adding cost and confusion.
Then came the process of deprescribing.
Deprescribing does not mean stopping medicines carelessly. It is a structured medical decision to reduce, withdraw, substitute, or simplify medicines when the harms, costs, duplication, or lack of benefit outweigh their usefulness.
It must be done thoughtfully, especially in patients with heart disease, diabetes, epilepsy, psychiatric illness, those taking blood thinners, steroids, sleeping pills, or long-term pain medicines. Some medicines can be stopped immediately; others need tapering. Some must not be stopped without specialist input.
WHY LESS CAN SOMETIMES BE MORE
By the end of the consultation, this patient’s prescription drugs had been reduced by almost half. Among the supplements, all except two were discontinued. More importantly, the patient finally understood her prescription. She knew which medicines were essential, which were temporary, and which had been removed.
This is the real value of a deprescribing consultation. It does not merely reduce the number of pills; it restores clarity. It tells the patient that more medicines do not always mean better care. It reminds doctors that our responsibility is not only to prescribe, but also to review, simplify, and deprescribe when appropriate.
Every patient with multiple chronic diseases should periodically ask for a medicine review. Every family should maintain an updated list of medicines. Every doctor should ask, “What are you actually taking?”
A brown bag consultation is simple, inexpensive, and powerful. It can reduce pill burden, prevent harm, cut unnecessary expenses, and empower patients to take control of their health.
In modern medicine, wisdom does not lie in adding one more pill at every visit. Sometimes, the most healing prescription is the one that safely removes what is no longer needed.
(Dr. Chandrakant Lahariya is a specialist in preventive and cardiometabolic medicine and an internationally certified metabolic health coach, based in New Delhi)
