May is a special month for me. My birthday and wedding anniversary are both in May. May is also the month I graduated from medical school. That was 38 years ago, and a lot has changed. New advances in technology, treatments, surgical techniques, and much greater knowledge of diseases have dominated the headlines. One other change that I find pretty disturbing is the number of prescription medications patients are taking. When I started to practice, most patients were averaging 3-4 different medicines that they took each day. This number has increased drastically to where patients are now taking ten or more different medications each day. I recently had a patient on 26 medicines, and he took each multiple times daily. You might get 2 or 3 prescriptions from your primary care provider, two from your cardiologist, 1 or 2 from your rheumatologist, etc. Before you know it, you’re organizing your day around your medication schedule.
Another huge change in medicine has been the widespread use of electronic medical records or EHR. While they do have their faults, they do have some incredible advantages. One of these is a drug interaction warning system. When a new patient comes to the office, we enter all of their medications in our EHR. As we enter the medicines, a flashing red warning comes up if we enter two drugs that interact with each other. One drug may lessen or inactivate another medication or even exaggerate the effects. In other words, I might prescribe a glaucoma medication for a patient that might interfere with a different treatment prescribed by their pulmonologist. A physician might think they are adequately treating a patient’s disease while unwittingly having their treatment plan undermined by another physician’s treatment plan.
I am constantly amazed at the number of times in a day that the flashing red warning comes on as I enter patient’s medication into their chart. One would think that with EHR, identifying medication interactions would be simple, but that doesn’t always happen. This is just one small part of the massive amount of information generated by the EHR. A true information overload. That means many of the medications you are taking may not be working because another drug inactivates them. Sometimes the medication interaction may cause one drug to have an exaggerated effect, leading to toxicity.
I told you earlier that my birthday is in May and this year, I turn 65. Meaning, I get to sign up for Medicare and choose a part D drug plan. Aetna Medicare provides an online tool that helps you select a plan. You can enter your medicines and see what it will cost you a month.
Just enter your zip code and follow the links. Out of curiosity, I started entering some of the medications most of my patients are taking. It quickly became evident that if you take more than just a few medications, especially some of the new brand-name drugs, the cost will become prohibitive. Even with insurance, I couldn’t afford to take 10 to 15 different prescriptions each day. The only conclusion I can reach is that many patients are not taking all of the medications they are prescribed or take them much less frequently to stretch out their medicines. Needless to say, this may be very detrimental to your health. What’s a patient to do?
DO NOT CHANGE ANY MEDICATIONS ON YOUR OWN
Adjusting or changing your medications can be extremely dangerous. Have a very frank and open discussion with your doctor. Make sure to tell them ALL of the medicines you take, including over-the-counter vitamins and supplements. Be completely honest about how often you take each medication. A sage professor in medicine once told me that there is no such thing as a patient being non-compliant with their medications. If a patient is not taking their medication, it’s because they CAN’T take their medicine. Either cost, side effects, or other problems prevent them from taking their medicines.
Ask if every medication is necessary. If you can’t afford a medication, be upfront and tell your doctor. Up to 30% of some new prescriptions are not picked up at the pharmacy. Tell your doctor about any side effects you might be having. You certainly are less likely to take medication if it bothers you. Ask for a cheaper generic if possible. The important message is to talk to your doctor about your medications. You need to take responsibility; it’s your health, it’s your life.
What is the goal for getting off of medicines? If you lose a lot of weight, get in shape, and clean up your diet, can you eliminate some medication? After all, good health is our goal, not a lifetime of pills
This newsletter does not constitute medical advice. Make sure to contact your healthcare provider if you experience any of these conditions. Do not make any changes to your medications before consulting your physician