Comments on: Overmedication

By: James Hubbard, M.D., M.P.H.

James Hubbard, M.D., M.P.H. — Sat, 22 Nov 2008 21:46:17 +0000

Great post. You cover everything. If an older patient comes in with confusion or other mental problems, one of the first things I do is go over the meds, prescribed, otc, supplements, herbs. It can be one or the interaction of several.
Thanks

By: christie

christie — Sat, 22 Nov 2008 03:28:08 +0000

i am a nurse in an acute care hospital and am VERY particular when it comes to medication reconsiliation. i also have a great memory when it comes to meds my pt has been on in the past. i was taking care of an elderly male pt whi haad been in the hospital for about 2 weeks this visit, he was a frequent flyer from a nearby nursing home. I’d been taking caare of him at the hospital of anf on for about 5 years and he was normally VERY confused, disoriented and unable to ambulate to the point of being almost bedridden. this time, during my assessment, he was verbal, oriented, alert, and ambulatory. this was my first day of caring for him during this hosp. stay. i checked his current meds(which were none), versus the admit orders(which was “continue home meds”), to the med list from the nursing home. i noticed the nsg. home had only sent page 3 of 3 of his MAR, which consisted of only prn meds. On admit 17 of his routine meds got missed- heart meds, diabetes meds, diuretics, bp meds etc didn’t get continued. i notified his Dr. who said to restart them all. Instead, i suggested we NOT restart them and updated the Dr. on his improved mental and phisical status. Doc agreed. subsequently this man was duscharged home and lived a relatively normal life with his spouse for 6 more months until his death. true, he may have lived longer with the drugs, but his quality of life would have been worse. Home, walking, talking, loving, and visiting with friends and family OR in a nsg home confused, disorientd, unable to ambulate or feed yourself? you chose. frequently, at least twice a year, doctors and patients need to re-evaluate a medication regimine and decide what continues to be appropriate and what can be adjusted.

By: Lisa

Lisa — Wed, 19 Nov 2008 01:51:56 +0000

Expense is a huge factor these days. I have very few meds these days, as I am currently off all of my hormone replacements to facilitate baseline testing, but one of the two meds I still take daily is very expensive even with insurance. I’m going to talk to my doctor when I see him next week to start weaning off of it.

$1600+ a year is too much.

By: Too Many Drugs « Navigating Healthcare - Patient Safety and Personal Healthcare Management

Tue, 18 Nov 2008 19:40:29 +0000

[...] without the knowledge of other prescriptions the patient has been given or is taking.This post on Over medication covers the issue well and features some good advice on how to avoid the problems. The best advice [...]

By: Dr. Matthew Mintz

Dr. Matthew Mintz — Tue, 18 Nov 2008 14:52:04 +0000

Great post. I would add to #6 (be truthful about medications) to mention not taking medications due to costs. Even patients who take only generic medicines, cost can still be an issue. The economy is in the tank. Don’t be embarrassed to admit you skip a few pills to save a few bucks. If not, as Dr. Rob mentions, the physician will likely prescribe more pills or more expensive pills.

For a #10, I might add: Report any side effects you might be having, but don’t believe every symptom you have is a side effect of your medication.

This parallesl recommendation #9. The Wall Street Journal just posted and excellent piece on the nocebo effect, which is the opposite of the placebo effect, and basically states that if you think you are going to get a side effect, you will. Side effects that are listed on the information you get when you fill your prescriptions are in many cases NOT likely to be due to your medication. I blog about this extensively today. http://www.drmintz.com

By: Frank Drackman

Frank Drackman — Tue, 18 Nov 2008 10:00:04 +0000

First year in practice I saw a LOL with HTN who wanted her BP med refilled, a combination pill of Reserpine-Hydralazine-Diuretic. The medication was so old, even the Military Pharmacy didn’t carry it, but she didn’t care, since the pharmacy in her little town an hour away did, and it literally cost a nickle a day. Anyway, I talked her into trying something more modern, Propanolol. Once she got back from the ER for her broncospasm we tried some Captopril samples which made her cough like a trained Seal. Basically went through every major category of Anti-hypertensive until she finally asked…”Can I just have my Serp-a-Sat??” And don’t laugh, I know Barak Obama, and when we get National Health Care its gonna be the only anti-hypertensive on the formulary. And before you laugh, its one of the few actually shown to improve mortality, Google that S*** if you don’t believe me.

Frank, M.D.

By: Ken O.

Ken O. — Tue, 18 Nov 2008 09:14:23 +0000

Ok, I know this is dependant on the patient being honest about what they’re actually taking, but isn’t checking for adverse interactions one of the reasons why PHPs (at least in the UK, and including ER staff who’re contemplating a prescription beyond analgesia) mostly to all given access to a formulary?

Oh and Suzy, I sometimes have problems with reCaptcha too; I know enough about Human Factors stuff to know it’s at least sometimes down to where a missing bit or line is, and not me.

By: SeaSpray

SeaSpray — Tue, 18 Nov 2008 05:16:46 +0000

Thank you for yet another great post!

By: Suzy

Suzy — Tue, 18 Nov 2008 02:22:46 +0000

Pharmacists are an often-underutilized resource. They have cool computer programs that check interactions, side effects, etc., and because they know how often a prescription gets refilled, they sometimes have a better idea than we do whether the patient is actually taking it as prescribed, or at all.

P.S. Half the time I can’t read the reCaptcha words. Maybe I need new glasses, or maybe this site is only truly accessible to the pure of heart …