There's a
common affliction that's rampant in my practice, but it's not a
gastrointestinal condition. It's called
polypharmacy, and it refers to patients who are receiving a pile of
prescription and other medications. I
see this daily in the office and in the hospital. It's common enough to see patients who are
receiving 10 or more medications, usually from 3 or 4 medical specialists.
Of
course, every doctor feels that he is prescribing only what is truly
necessary. If an individual has an internist,
a cardiologist, a gastroenterologist, a urologist and a dermatologist – which is not unusual - and each prescribes only 2 or 3
essential medicines, then polypharmacy is created. Each day, the patient swallows a chemistry
set.
First of
all, I don't know how these patients, who are often elderly, manage the logistics
of taking various medicines throughout the day and evening, before meals, after
meals and at bedtime. Who can keep track
of this? Nurses in the hospital can
barely manage this overwhelming schedule.
This has to negatively affect one's quality of life as the daily
calendar of events is predominantly pill popping events.
Keep in
mind that the drugs we doctors prescribe are not that smart. Does the Nexium I prescribe to hundreds of
patients only act on just the right amount of stomach acid to relieve the
patient's reflux? Doesn't the drug reach
every organ of the body having potentially deleterious effects that we might
not be aware of? Could Nexium be
interacting with other medicines in an unfavorable manner? While we are quick to demonize stomach acid
as an enemy of mankind, isn't the acid that Nexium is reducing there for a
reason? Are we smarter than a few
million years of natural selection?
I'm betting on Darwin's theory.
Extrapolate
the Nexium example above to a situation when 10 or 12 drugs are cruising
throughout the body on a Fantastic Voyage journey, colliding with each other
and smashing into organs far away from the drugs' intended targets.
We also
function in a culture where every symptom demands a pharmaceutical
response. While depression,
hyperactivity and insomnia are real illnesses, can anyone dispute that the
medical community is over prescribing medicines for these conditions?
I wonder
how many folks who are suffering from unexplained nausea, balance issues,
confusion, dizziness, falls, bowel disturbances and abdominal pain are actually
getting a “taste of their own medicine”. When they present
these symptoms to their doctor, they may end up with yet another prescription
thrown onto the pile, when the solution is to diminish the pile which is
causing side-effects.
Challenge
your internist and your specialists to verify that every drug is truly needed.
Insist on the lowest dose that will accomplish the mission. Are the doctors on your team communicating
adequately with each other? Is someone
in charge?
In my
experience, the biggest risk factor for polypharmacy is polydoctor. More medicines and more physicians aren't
better medicine. Primum non nocere,
first do no harm, still deserves to be the mantra of the medical
profession. In medicine, less is more. On your next visit, ask your doctor to please
do less for you.