Good morning, Dr. Faust, I wonder if I was channeling your thoughts as you wrote this post? I am pushing back on the medications that my various specialists often suggest may help me with the various ailments we are trying to minimize. I ask about the side effects immediately. Too frequently, I see an expression of anger appear on my physician’s faces when I question the side effects. These discussions happened three times this past week. I recall one of your postings about your concentrated evaluation of a patient you may be treating as an ER physician. You told us that in many situations from your experience in the ER, you are able to evaluate the problem(s) a new patient might be suffering with in a matter of a minute or less. I believe this. I have a friend who is an ER physician. He told me that as he walks through the halls of the hospital where he practices, often he thinks of the number “30.” This is because he often learns that too many of his new patients are using as many as thirty different medications when combined with the OTC supplements they are using. The patients get seduced into trying a medication that is being advertised continually every fifteen minutes during television programming. Often, the medications being promoted are just a previously FDA approved drug that has been reformulated in order to allow it to be sold OTC. The last few seconds of those advertisements use a skilled voice actor to read the side effects at lightning speed making the list of side effects impossible to understand and almost comical to hear. If I use the poly-pharmaceutical term when talking with a new physician I might be meeting with sometimes I’m asked, “Are you in the medical field?” I explain that I just read too much.
Great subject to write about. I had a friend who was on at least 30 drugs. On top of other issues, that's a lot to keep track of and errors in taking medications is another variable in a complex problem.
As an old person (70), I take two prescription drugs daily. My list of prescribed drugs is very long, though, but some are occasionally used, some rarely used, and some were used once or twice in the past.
What I wonder about is drugs that are prescribed on the basis of one abnormal test result. My ophthalmologist prescribed latanaprost after one high intraocular pressure reading and now looks like I'm on it for life. I suspect it's pretty easy for a clinician to get into a habit of prescribing X for Y and moving on.
Well stated & yes I am a member of the "your choir" albeit somewhat more muted...haha
Catholic grade school, the nuns told me maybe just mouth the words. Ok perceived as cruel, not life altering. Ok to LOL
So my suffix title reveals my conviction to the above challenge & journey.Thoughts from my years of practice...🤔
Maybe we are all life long learner's.
If it's "not broken don't try to fix it" Ok but that's the immediate response. Not my original contribution, there must be patient/client "buy-in". Akin to the individual accepting they have a chronic condition (not likely requiring a multitude of med's).
Mary/Joe your high blood pressure &/or diabetes is not going away & yes you have to take your pills every day & not "most" days.
My gently reminders I occasionally refer to as the "confessional" Ok back to my upbringing...please 🙂 it's always intended light hearted, e.g. good guy, bad guy Mrs. usually the agent, "it's appears Mr. has missed some days". Yes open-ended that being "professionally correct" once again Ok to 🙂
Compliance with medication is huge... we don't need a plethora of new agents, simply take what we know has a long history of efficacy, known side effects & generally few surprises.
The thoughtful ER doc such as yourself & many others plant the seed for change. If time permits the note to the family doc may help. Not intended as self serving, however consider a copy to the patients Phm. Without question the polypharmacy/multitude of med's some (too many) receive are frequent visitors to their pharmacy.
Return, to the buy-in, only after having a trust relationship can a HCP (not that he/she didn't believe you) can change being effected. Possibly somewhat a decision on the part of the patient to understand it's their choice to agree &/or accept the change.
Now, the turf-battle many prescribers push back when offered a "respectful suggestion". Believe me when I say, almost 40 yr's "practicing", my younger colleagues comment on my "gentle request for change or correction".
Pardon the rather winded response. I remain passionate with what I do & grateful when simply tasks upon completed are mutually appreciated.
Take care,
p.s apologies for any typos, yet to master post-edits
Not a perfect system, however in my province the funding for most med's administered in nursing homes, they'll home has a contract with a given pharmacy.
That pharmacy is reimbursed via a provincially funding system & the pharmacy is required to perform quarterly med-reviews.
The expectation any med's that are maintainence are being scrutinized 🤞with a follow-up to the attending physician if changes are warranted.
Can you define what ages "older Americans" are? I didn't see it delineated here. Maybe everyone except me just knows? :-) Is there a range (like 65-100) or is it "over" some age, like 50, 60, 65, 70, 80? As a 62-yr-old who has never taken a Rx long-term (for more than 2 weeks) and takes none now, I'm curious.
Are there any recent research articles on nursing home residents having too many prescriptions? Just wondering 🤔 how many maintenance meds people 80- 100 years old need ? (Generally speaking for fall risk increasing and confusion etc., increased side effects)
Good morning, Dr. Faust, I wonder if I was channeling your thoughts as you wrote this post? I am pushing back on the medications that my various specialists often suggest may help me with the various ailments we are trying to minimize. I ask about the side effects immediately. Too frequently, I see an expression of anger appear on my physician’s faces when I question the side effects. These discussions happened three times this past week. I recall one of your postings about your concentrated evaluation of a patient you may be treating as an ER physician. You told us that in many situations from your experience in the ER, you are able to evaluate the problem(s) a new patient might be suffering with in a matter of a minute or less. I believe this. I have a friend who is an ER physician. He told me that as he walks through the halls of the hospital where he practices, often he thinks of the number “30.” This is because he often learns that too many of his new patients are using as many as thirty different medications when combined with the OTC supplements they are using. The patients get seduced into trying a medication that is being advertised continually every fifteen minutes during television programming. Often, the medications being promoted are just a previously FDA approved drug that has been reformulated in order to allow it to be sold OTC. The last few seconds of those advertisements use a skilled voice actor to read the side effects at lightning speed making the list of side effects impossible to understand and almost comical to hear. If I use the poly-pharmaceutical term when talking with a new physician I might be meeting with sometimes I’m asked, “Are you in the medical field?” I explain that I just read too much.
Great subject to write about. I had a friend who was on at least 30 drugs. On top of other issues, that's a lot to keep track of and errors in taking medications is another variable in a complex problem.
As an old person (70), I take two prescription drugs daily. My list of prescribed drugs is very long, though, but some are occasionally used, some rarely used, and some were used once or twice in the past.
What I wonder about is drugs that are prescribed on the basis of one abnormal test result. My ophthalmologist prescribed latanaprost after one high intraocular pressure reading and now looks like I'm on it for life. I suspect it's pretty easy for a clinician to get into a habit of prescribing X for Y and moving on.
Well stated & yes I am a member of the "your choir" albeit somewhat more muted...haha
Catholic grade school, the nuns told me maybe just mouth the words. Ok perceived as cruel, not life altering. Ok to LOL
So my suffix title reveals my conviction to the above challenge & journey.Thoughts from my years of practice...🤔
Maybe we are all life long learner's.
If it's "not broken don't try to fix it" Ok but that's the immediate response. Not my original contribution, there must be patient/client "buy-in". Akin to the individual accepting they have a chronic condition (not likely requiring a multitude of med's).
Mary/Joe your high blood pressure &/or diabetes is not going away & yes you have to take your pills every day & not "most" days.
My gently reminders I occasionally refer to as the "confessional" Ok back to my upbringing...please 🙂 it's always intended light hearted, e.g. good guy, bad guy Mrs. usually the agent, "it's appears Mr. has missed some days". Yes open-ended that being "professionally correct" once again Ok to 🙂
Compliance with medication is huge... we don't need a plethora of new agents, simply take what we know has a long history of efficacy, known side effects & generally few surprises.
The thoughtful ER doc such as yourself & many others plant the seed for change. If time permits the note to the family doc may help. Not intended as self serving, however consider a copy to the patients Phm. Without question the polypharmacy/multitude of med's some (too many) receive are frequent visitors to their pharmacy.
Return, to the buy-in, only after having a trust relationship can a HCP (not that he/she didn't believe you) can change being effected. Possibly somewhat a decision on the part of the patient to understand it's their choice to agree &/or accept the change.
Now, the turf-battle many prescribers push back when offered a "respectful suggestion". Believe me when I say, almost 40 yr's "practicing", my younger colleagues comment on my "gentle request for change or correction".
Pardon the rather winded response. I remain passionate with what I do & grateful when simply tasks upon completed are mutually appreciated.
Take care,
p.s apologies for any typos, yet to master post-edits
Not a perfect system, however in my province the funding for most med's administered in nursing homes, they'll home has a contract with a given pharmacy.
That pharmacy is reimbursed via a provincially funding system & the pharmacy is required to perform quarterly med-reviews.
The expectation any med's that are maintainence are being scrutinized 🤞with a follow-up to the attending physician if changes are warranted.
Can you define what ages "older Americans" are? I didn't see it delineated here. Maybe everyone except me just knows? :-) Is there a range (like 65-100) or is it "over" some age, like 50, 60, 65, 70, 80? As a 62-yr-old who has never taken a Rx long-term (for more than 2 weeks) and takes none now, I'm curious.
Hi yes, the studies use 65+ as the definition.
Are there any recent research articles on nursing home residents having too many prescriptions? Just wondering 🤔 how many maintenance meds people 80- 100 years old need ? (Generally speaking for fall risk increasing and confusion etc., increased side effects)