As an internist, I willingly prescribe medications. On rounds we often discuss which medications a patient is taking and which he/she should take. Often we find that the patient takes too many medications. Experts Say Americans Are Overmedicating
The problem is understandable. Over the past 30 years, we have available many more useful medications. However, each medication has pros and cons, pluses and minuses, benefits and risks. Too often patients receive prescriptions from several physicians. In these cases, the patient lacks a conductor – someone to coordinate the symphony. And patients need someone to coordinate their care.
The big mistake in the primary care promotion of the late 80s and early 90s was the use of gatekeeper as the metaphor. Conductor should replace gatekeeper. As a generalist, I should know all of my patients medications – and be responsible for minimizing the number.
Just because a patient has a problem which has a potential pharmaceutical treatment does not mean we have to prescribe that treatment. Some problems do require pharmaceuticals – because we know that their use improves morbidity and mortality.
Do we need all these drugs? A relative handful yank many people away from almost certain death, like some antibiotics and AIDS medicines. Though carrying some risk, other drugs — such as cholesterol-cutting statins — help a considerable minority dodge potential calamities like heart attack or stroke.
The right balance of risk and benefit is still harder to strike for a raft of heavily promoted drugs that treat common, persistent, daily life conditions: like anti-inflammatories, antacids, and pills for allergy, depression, shyness, premenstrual crankiness, waning sexual powers, impulsiveness in children — you name it.
“We are taking way too many drugs for dubious or exaggerated ailments,” says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of “The Truth About the Drug Companies.”
“What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people. Why? Because it’s the biggest market.”
For patients – make certain that each medication has a necessary purpose. For physicians – spend some time to consider each medication – and then determine which ones you can eliminate. The patient might just feel better without the medication.
