Friday, April 18, 2014

When the best medicine is less medicine

            A majority of our medical education is devoted to the rote memorization of medical facts and than later to the practical application of that knowledge. As an internist this commonly involves the use of various medicines for treatment of ailments. However we must always be vigilant of when stopping medicine may be the best approach.

            I recently established care with a 87 year old woman who had recently moved to the area to be closer to her daughter.  By outward appearance she was a healthy highly functioning individual. After a brief discussion she handed me her medication list, which included 18 different medications and vitamins, many of which are scheduled three times a day or four times a day. After a brief discussion it became apparent the woman was under a tremendous amount of distress from the expense of the medications and difficulty of keeping medications straight. Additionally on review of systems she voiced many complaints that could easily be related to several of her medications.

            Although to any practitioner it was very clear that the patient needed to have some of the medications stopped this discussion can be much harder than expected. After getting push back from the patient and her daughter on stopping any medications we were able to stop only one medication at that visit with the plan to follow-up next month and evaluate if she noticed any changes.

-- Andrew Illif

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