Too Many Ills, Too Many Pills, Too Many Bills

   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.