If I had 60 seconds to review a med list, I wouldn’t try to analyze every detail. That’s the biggest mistake clinicians make when time is limited. Instead, I rely on pattern recognition—quickly scanning for a handful of high-yield problem areas that consistently lead to harm, unnecessary medications, or missed opportunities to simplify therapy. Over time, you realize you don’t need to catch everything in that first pass—you just need to catch the right things.
The first thing I look for is duplicate therapy. This is one of the easiest wins in a busy clinical setting and surprisingly common, especially during transitions of care or when multiple prescribers are involved. Sometimes it’s obvious, like two statins on the medication list. Other times, it can be numerous medications treating the same condition. Insomnia is a common complaint that can lead to multiple medications. Melatonin, trazodone, zolpidem, and mirtazapine are commonly used agents that can add up.
Next, I quickly scan for high-risk medications. These are the drugs that tend to cause the most problems, particularly in older adults or medically complex patients. You don’t need to memorize every list to do this well—just being aware of common offenders like anticholinergics, insulin, seizure meds (and other medications that may require drug levels), benzodiazepines, opioids, antipsychotics, and sedative-hypnotics will get you most of the way there. In many cases, these medications were started for a good reason, but that reason may no longer apply, or the risk-benefit balance may have shifted over time. In addition to the medication, I’m also scanning the dosages. Quetiapine 12.5 mg at bedtime is a lot less likely to cause adverse effects than 200 mg.
After that, I look for signs of a prescribing cascade. Prescribing cascades happen when a medication is started to treat the side effect of another medication, rather than addressing the root cause. Let’s use amitriptyline as an example. If I see this medication on the list, I’m looking for other medications that may be used to manage its adverse effects. If you see medications for dry eyes, constipation, urinary retention, or memory impairment, it is a good bet that amitriptyline’s adverse effect profile is likely contributing to the prescribing cascade.
Obvious drug interactions and contraindications are important to assess. Using NSAIDs with anticoagulants and PDE-5 inhibitors with nitrates are a couple of examples of serious drug interactions. An example of a contraindicated medication that may be recognized by the med list is bupropion. If you see a patient taking levetiracetam and receiving bupropion, you should recognize that this patient likely has a seizure disorder, and bupropion should be avoided in this patient population (excellent board exam nugget).
When you put it all together, this 60-second review is all about focusing on obvious and high risk concerns. You’re not trying to solve every problem—you’re identifying the highest-yield opportunities for intervention. Duplicate therapy, high-risk medications, prescribing cascades, drug interactions, and contraindications will show up again and again, regardless of the setting. If you can consistently recognize these patterns, you’ll make a meaningful clinical impact even when time is limited.
What else would you look for if you only had 60 seconds?
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