By Michael Kirsch, MD, Center for Digestive Health and Endoscopy Center
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? 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. Do we really think that these drugs only reach the intended target? Or, do they reach every organ of the body having potentially deleterious effects that we might not be aware of? Could they be interacting with other medicines in an unfavorable manner? More likely, these 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.
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.
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