A 78-year-old man, four years on warfarin for atrial fibrillation, admitted with a surgical site infection. The on-call resident is about to add metronidazole. It is the obvious empirical choice. He is tired enough that he might prescribe it without thinking.

He types the order into the system. Below the new order line, a single sentence:

Possible interaction: metronidazole + warfarin. INR may rise within 3–5 days. Consider azithromycin if anaerobic coverage is not essential. Otherwise: drop warfarin to ½ dose, check INR daily, hold warfarin if INR > 4.

He switches to azithromycin. Three days later the patient's wound is clean and his INR is 2.4 — unchanged.

This is the geriatric polypharmacy trap. The average elderly patient on a medical ward in India is on 6–8 chronic medications. The average admission adds 2–4 acute ones. The combinatorics of interactions is large enough that no resident can hold the full picture in their head.

The published data on this is grim. Hajjar and colleagues (Am J Geriatr Pharmacother, 2007) found that adverse drug events were responsible for 16% of hospital admissions in patients over 65 in their cohort. Of those, an estimated 60% were potentially preventable — the interactions were known, the at-risk patients were identifiable, the system simply did not catch them at the point of prescribing.

Drug-interaction checking is a feature in most pharmacy software. It is rarely a feature embedded in the act of prescribing on the ward. The resident on the ward is using paper, an EHR for documentation, and a separate drug reference if they bother. The interaction check happens, if at all, when the pharmacist dispenses — which is too late to influence the prescribing decision without a friction-laden callback.

In Medows, the AI consult is grounded in the patient's active medication list. When the resident considers an addition, the interaction check runs automatically — a single sentence, in line with the order, citing the relevant evidence. It is not a modal. It is not a blocking dialog. It is the equivalent of a pharmacist quietly noting something next to the order while the resident is writing it.

The point is not to replace the pharmacist. The point is to have the catch happen during the prescribing decision, when the resident still has the full clinical context fresh.