Sometimes less is more. Next time you see your doctor ask about ‘de-prescribing’ |
“I thought I was never supposed to come off these tablets!” my patient exclaims.
“Except when you no longer need them,” I say.
His doubt drifts in like fog.
His advanced cancer has long had him feeling out of sorts – and, in his late 80s, he yearns for quality of life.
At diagnosis, my patient was taking an astonishing 17 pills a day. The original culprits were those taken for heart disease, diabetes, stroke, gout, reflux and anxiety. When he developed cancer, new doctors threw in extra drugs. Whenever he was admitted with a complication, other doctors added more.
The discharge summary might have said “GP to review” but my hapless patient barely makes it to his GP – and when he does, the GP assumes that the specialists have things in hand.
His daughter and chief gatekeeper furnishes a list of medications – now 25 pills a day – and the dismay on my face is obvious.
“By the time I swallow my tablets, I feel too full to eat,” the patient announces morosely.
It’s no wonder he feels full and confused. A cursory glance reveals that most of his drugs are no longer relevant and, moreover, potentially harmful.
Given his significant weight loss and dizziness, the multiple antihypertensives can go. With a limited life expectancy, the statin is useless. Factoring in his increasing falls, the blood thinner has crossed into risky territory, especially alongside the diabetes drugs plunging his blood sugars.
He suffered anxiety many years ago........