Background: Empowering patients to be more proactive in managing their medication information and engaging them in shared decision making is an important step towards optimizing drug therapy and preventing medication errors. Objectives: To investigate patients attitudes and beliefs about creating and managing their personal medication list and its impact on communication and shared decision making with health care providers. Methods: Survey and structured interviews among a consecutive sample of patients attending the pre-operative clinic for elective surgery at UCSF September 2009 March 2010. Survey data were analyzed using descriptive statistics and qualitative data were analyzed to identify common themes for maintaining or not maintaining a medication list. Results: Of 192 eligible patients, 140 patients completed the survey (73% response rate). Patients averaged 61 years of age (range 22 89 years), 51% male, predominantly Caucasian (77%) and completed some level of college education (78%). Most patients brought a medication list to their clinic visit (79%) after receiving telephone reminders and written instructions from clinic staff, however few reported that a health care provider recommend they maintain a medication list and discuss it at every health care visit (36%). Among the 111 patients with a list, 87% reported improved communication with their doctor and common reasons for maintaining a list included improved self-management of their medications and convenience. Common themes among patients without a list included lack of importance or need (e.g., can remember their medications) and expectations that providers and hospitals will maintain accurate medication information within their health records. Conclusions: Personal medication lists maintained by patients provide an opportunity to improve communication and facilitate shared decision making between patients and health care providers. Interventions that encourage and empower patients to maintain a medication list and make it accessible for review with providers are needed.