Why you must review your medicines regularly

Doctor warns that it’s critical to review any medicines regularly to see if changes are warranted.

Why you must review your medicines regularly

“I’ve been on my gout medication since the 1990s. No one ever suggested I stop taking it, doc,” Jerry told Dr John Whyte during a general health check-up.

Jerry explained that he had a variety of health conditions and was taking at least six different medicines. When he was asked how long it had been since his last gout flare-up, he proudly replied: “I haven’t had one in 20 years.”

Dr Whyte says that Jerry’s experience isn’t unusual, that he maybe hasn’t had a recurrence in two decades because he’s been on the medicine, or maybe he doesn’t need to be on the drug anymore.

“Many older patients are still taking medication that had been prescribed to them when they were much younger, without anyone questioning whether they should still be taking it,” says Dr Whyte, chief medical officer at WebMD.

“Think about it – has your doctor ever comprehensively reviewed all your medicines with you – and discontinued one or lowered a dose?”

Dr Whyte says it is critical that we regularly review our medications with our doctors to see if any changes are warranted.

“Every drug has risks and benefits, and that balance can sometimes shift as we age. 

“In fact, certain drugs should be outright avoided as you get older. Yet, most older patients are unaware of this.”

Dr Whyte explains that this was one of findings that had surfaced in a survey on age-friendly health systems conducted by WebMD and The John A. Hartford Foundation.

“We surveyed nearly 3000 patients and caregivers, aged 65 and older, and the results were a bit sobering,” he says. “We learnt that the care of older adults is mired in misinformation, especially among minority populations, with older patients and caregivers mistakenly believing that sharp declines in the quality of life are inevitable.

You can learn more about the survey results here, but some of the most concerning findings were:

  • Forty per cent of those surveyed were unaware that certain prescription medications affect the quality of their thinking.
  • More than two-thirds of caregivers said that the person in their care had difficulty walking around and half said they had fallen within the past year. Very few were doing any activities to improve mobility.
  • Only a very small percentage talked to their doctors about their concerns and fears or shared their future health goals.
  • Forty per cent of respondents incorrectly thought that depression was an inevitable part of ageing.

So, why are many older patients not getting the care and the information they need?

Dr Whyte says: “I think part of the reason is that patients and caregivers often aren’t sure what to expect – and what they should demand – from doctors and the healthcare system. They just accept the status quo, but we need to change that.

“Patients and caregivers need to know that they can and should ask for care that meets their specific needs.”

Medical advances and a greater focus on healthy eating and general wellbeing mean we are living longer. But now we need medical care that will help to optimise our health as we age.

Dr Whyte says we need age-friendly care that is evidence-based, causes no harm and is always consistent with what matters to the older person.

But that kind of change will only happen if patients and caregivers ask for it and start to expect it, he says.

And, in case you are wondering, Jerry did stop his gout medicine and he has been doing very well.

Do you regularly review any medicines you are taking? Do you question the need for the medicine?

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    Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.





    COMMENTS

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    Horace Cope
    15th Jan 2020
    11:32am
    We have a good doctor who, sadly, is about to retire. He has always talked to the family about their medication and is quick to bring in any improved medication. He always checks if we are taking the medication as prescribed and will also recognise natural remedies with the warning that he should be consulted if we are considering taking any natural remedies in the event that there is a conflict. Maybe our doctor is "old school" that is the difference.
    Bren
    15th Jan 2020
    12:36pm
    I have taken Allopurinol for gout everyday for the last 8 years. Once I missed my dose for 2 consecutive days . The result : the worst gout attack I have ever had.

    One needs to be weaned off this medication slowly or else (see above).
    Laura52
    15th Jan 2020
    12:44pm
    Bren, as a pharmacist I concur. One shouldn't suddenly cease medication unless in consultation with a pharmacist and the doctor. Gout needs to be regularly monitored with blood tests to determine the level of uric acid.
    KSS
    15th Jan 2020
    1:23pm
    You need to come off medication (any medication) only with the involvement of your doctor. It is not the role of a pharmacist to consult on the removal, or dosage alteration of any medication prescribed for the patient.

    I am fully aware that pharmacists are pushing for a greater role to play in frontline medicine, but until they qualify as a GP or other medical specialist, they should stick to dispensing prescribed drugs not altering them.
    Laura52
    15th Jan 2020
    1:59pm
    Kss in this issue, my advice to the patient would be to consult the doctor first. Pharmacists do not tell patients to cease medication or change doses unless a doctor advises to do so. After consultation with the doctor, it is officially documented by the pharmacist on the patient's history. If you do not believe me, speak with your local pharmacist, who has 5 years of intensive training. Dispensing involves more than sticking a label on the bottle. I identified major overdoses which could have led to undesirable circumstances. Of course, I paged the prescribing doctors immediately. Fortunately, in that situation major occurrence was prevented in time.
    Bren
    15th Jan 2020
    12:36pm
    I have taken Allopurinol for gout everyday for the last 8 years. Once I missed my dose for 2 consecutive days . The result : the worst gout attack I have ever had.

    One needs to be weaned off this medication slowly or else (see above).
    Laura52
    15th Jan 2020
    12:42pm
    I am a community and hospital pharmacist. Pharmacists are trained to do medication reviews, and are experts at medications with 5 years of training, moreso than doctors who don't get intensive training in pharmacology and medication reviews. Why not ask your local pharmacist or get your doctor to ask a specialised pharmacist to do a home medication review. This is subsidised by Medicare
    Horace Cope
    15th Jan 2020
    12:47pm
    Thanks for that Laura52, I am reminded of the odd occasion where our pharmacist had to telephone our doctor to clarify a new medication which may have clashed with an existing medication. Our doctor always deferred to the pharmacist. Each to their own unique skills.
    Laura52
    15th Jan 2020
    1:01pm
    Thanks Horace, when I worked in the hospital system, young and experienced doctor's would rely on the pharmacist for drug information, dosages and drug interactions. No one is perfect, but mistakes are made and the pharmacists job is to identify errors with dosages, in particular paediatric doses, and drug interactions, and even if the medication is correct for the diagnosed condition. Community pharmacists are also trained for this. I don't hesitate to call a doctor if I see a prescribing error , over or underdose, or a medication review is required. Doctors are more trained with diagnosis and pharmacists are trained in how medications work, dosing, side effects...
    KSS
    15th Jan 2020
    1:31pm
    Until and unless pharmacists are given diagnosis and prescribing rights, advice should come through the doctor - not over the counter at the local chemist shop.

    And IF the pharmacist is concerned about the type or amount of a medication that has been prescribed then the best practice thing to do is talk to the prescribing doctor about their concerns, not advise the patient contrary to the doctor's prescription. People can use a number of different chemists to fill their prescriptions, so, despite their inflated opinion of their abilities, pharmacists do not have the patient's medical history or even an up to date current medication list and thus are not in a position to advise the patient on anything except the specific drug being dispensed at that time.
    Laura52
    15th Jan 2020
    1:48pm
    Thanks for your comment kss I am a hospital clinical pharmacist, having worked in paediatrics, and in an adult setting, in 3 hospitals and pharmacists always consult the doctor first on medication and other issues. Yes, people use different pharmacies hence that is why pharmacists consult the doctor first. I have 30 years of experience clinically and in a community setting with 2 degrees including , pharmacology in honours, so I know what I am talking about when it comes to patient care, which always come first.
    JoJozep
    15th Jan 2020
    2:40pm
    What are our doctors doing? What are we paying them for? Are we to do self diagnosis?

    This doctor is trying to shift the responsibility for prescription medication onto the patient, so the doctor can claim "I told you to be vigilant and report medication not working" WHY is he asking a retired pensioner if the medication is effective, shouldn't he know through his examination of the patient?

    Is this an insurance ploy, or a means whereby the doctor can claim innocence (If they get sued for malpractice). I'm sure they can't claim ignorance.

    It's the doctor's responsibility to periodically check on their patients, not the other way round. The doctor claiming he has too many patients to monitor is a greedy no-hoper. He must stop seeing new patients immediately unless it's a serious emergency and the patient can't see anyone else.

    My doctor is brilliant, I've been seeing him for over 20 years, he bothers to find out how I'm really travelling and looks for vital signs some thing could be wrong. He is not scared to change my medication. He also tells me why he thinks the medication can be replaced by one which has fewer side effects or is more effective.
    morrowj1122
    15th Jan 2020
    3:00pm
    I admire your patience Laura52.


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