Polypharmacy is something I’m extremely passionate about. In my work as a consultant pharmacist, there isn’t a much better feeling for me than eliminating medications that the patient doesn’t need. To successfully minimize polypharmacy (check out my 10 commandments), I think it is critical to identify the most important reasons why we don’t reduce medications.
Fear of Patient Discomfort
No one enjoys seeing someone suffer. Indeed, this is a risk with reducing medications. Whether it is an opioid for chronic pain, PPI for heartburn, or pramipexole for restless legs, we do have to recognize that tapering and discontinuing a medication could lead to the patient being uncomfortable or in some cases cause significant pain. This fear of the patient’s problem returning and an increase in pain and suffering can prevent both the patient and provider from trying to reduce medications.
Time For The Conversation
In my practice as an ambulatory care pharmacist, it was obvious to me that providers do not have enough time to proactively review and reduce medications. Most clinic visits are in relation to a problem and more often than not, the answer to that problem is a medication or treatment. Dedicated time is rarely set aside to review chronic treatments and identify if they are all still appropriate and necessary. Maybe this should be a mandatory piece of Medicare’s Annual Wellness Visits?
Future Time Burden
When medications are tapered and discontinued, inevitably, there is a chance that it won’t work and the patient will want to go back on the dose that they were previously on. With prescription medications, that is likely going to lead to more work. Even though tackling polypharmacy is the right thing to do, it is extra work. Extra work is generally not something most providers aren’t actively seeking. If you are looking for case studies and clinical pearls on polypharmacy, you have to check out my book, the Perils of Polypharmacy – Audible Will Give You Your First Book For Free With This Link.
What other reasons do you have for why we don’t reduce medications?
- 30 medication mistakes PDF
- 18+ Page Drug Interaction PDF
- 10 Commandments of Polypharmacy Webinar based on my experiences in clinical practice
Diseases are more complex and its management much more complex