Polypharmacy Prevention: 7 Tips to Reduce Medication Risks

[00:00:00]modern medicine has brought many marvelous modernizations to the treatment of disease and the prevention of disease but there is one thing that modern medicine has brought us that can be quite dangerous in fact it can be completely devastating to your health and to your future if you're not aware of it and not aware of these seven steps that you can use to prevent polypharmacy from happening to you i'm dr ken berry a family physician let's talk about polypharmacy why it's such a big deal for you and your loved ones and then we'll talk about seven ways that you can prevent polypharmacy from ever happening to you or someone you care about so first of all let's talk about what's polypharmacy it's such a new concept it's only been around for a decade or so that mainstream medicine hasn't really decided on a definition of it yet but the accepted definition is if you're on five or more medications prescribed by a doctor or a list of doctors then that's polypharmacy and your risk for having either medication misadventures which is a pretty way of saying that you had a bad outcome because of being on too many medications or sometimes disastrous side effects or complications can come from polypharmacy when you're taking one or two medications and your doctor prescribes a third medication to go with that you don't just double your risk of drug interactions and side effects you actually triple or quadruple the the risks now it's not a guarantee that you're going to have any of these but the risk the likelihood the chances of go up almost astronomically for each new medication that's added to your current medication regimen so i want you to understand very clearly what this could potentially mean for you or for someone you care about who is suffering from polypharmacy patients can have a decreased quality of life they can have the decreased ability to be mobile in other words to get around under their own locomotion patients can have increased mortality they can have increased morbidity you can you're actually much more likely to be uh placed into a nursing home when you don't really need that due to polypharmacy there's so many things that polypharmacy can lead to that you don't want i promise so please pay attention to the seven tips i'm gonna give you at the end of this video uh maybe even commit them to memory or write jot them down because you don't want this to happen to you you don't want someone you care about including yourself to wind up in a nursing home prematurely thinking that you're now demented when really you're just suffering from the side effects and drug interactions of polypharmacy it's estimated that a large percentage of the frailty in older people of the disability of the falls of just weird side effects coming out of nowhere in people over the age of 40 is very very commonly due to polypharmacy and not due just to being older polypharmacy is going up as a just the percentage of people on five or more medications is going up almost astronomically a 2015 report showed that from the year 2000 to the year 2012 the percentage of people on five or more medications doubled just in that short period of time and that trend i promise you continues to this very day and that's very concerning because of all of the drug interactions and potential side effects that can come from that this puts older people at much greater risk now even a young person in their teens or twenties who's on five or more drugs prescriptions they're gonna notice that they have many more side effects some of which can be disabling but as you get older polypharmacy becomes a much much bigger deal one of the things that polypharmacy can bring on is a prescribing cascade which not only makes the polypharmacy worse but then can also make the the drug interactions and the side effects worse as well so for example you're taking one of your five medications you're taking is giving you heartburn and your doctor rather than uh looking at your medication list with fresh eyes and saying well wait a minute what are your drugs that you're taking it can cause heartburn maybe we should stop that medication or change it they just prescribe you a new medication for the heartburn and so now you're taking six medications and so then you have uh you're having trouble with your memory and instead of the doctor saying well you know the poor person's on five medications perhaps that's harming their ability to remember things they start you on an alzheimer's medication because of your failing memory never once even considering the fact that polypharmacy is the reason you now have heartburn and that you now have a failing memory and that you now perhaps have insomnia and multiple other side effects there are multiple other new symptoms that your doctor is treating as a new thing when really it's coming from the polypharmacy the reason in my opinion that polypharmacy is becoming such a big deal in a negative way is that doctors are trained very well on how to prescribe medication but very few doctors ever receive any meaningful training on how to de-prescribe and in my opinion deep prescribing is a much more powerful therapeutic tool than prescribing a medication and so hopefully as polypharmacy and the the terrible outcomes that go along with it become more on the radar of modern medicine i'm hoping that more and more doctors will embrace the concept of de-prescribing and the seven tips i'm about to give you you're going to help remind your doctor that if anything you'd rather them stop a medication rather than start a new medication now if you've been listening this video thinking well now wait a minute i'm the patient it's it's not really really my job to be considering whether i need to start or stop a medication or if i'm taking too many medications that's not really my job and i don't feel like it's my place perhaps to say out loud to my doctor the seven things that you're about to recommend that i say to my doctor and i would caution you that although it is not your fault that polypharmacy is your problem it is indeed your problem that polypharmacy is your problem and you have to understand this doctors are very good at prescribing many of them are terrible at the prescribing in fact the thought never occurs to them uh doctors actually can charge a higher level of service if you have more diagnoses in your chart they can charge a higher level of service office visit the more medications that you're taking and so i'm not saying that they're putting you on more medications just to charge a higher level of service i'm saying that the human nature of this issue is first of all they're not trained to de-prescribe secondly they actually get paid better if they don't de-prescribe you can kind of see how it would be kind of easy for a doctor to forget to mention that perhaps you don't need all the medication that you're currently taking so here are seven easy tips that you can use to prevent polypharmacy in in both your case and in the case of anyone you care about and if also you can use these seven tips that if you already suffer from polypharmacy you can use these seven tips to slowly but surely get polypharmacy out of your life and out of your medical chart tip number one is every single time you see your doctor you're going to take every medication that you've been prescribed by any doctor not just that doctor you're going to take every over-the-counter medication that you take even if it's not a prescription medication and your supplements you're going to put them all in a big brown bag and you're going to have a brown bag session with your doctor you're going to lay them all out on the exam table and say this is everything i'm taking are there any drug interactions are there any of these drugs that i no longer need to take are there any of these drugs that i can safely decrease the dosage of and finally are there any drugs that we can just not renew and not prescribe them anymore so i can take them off my list this is one of the most powerful tools that you can use as a patient to protect yourself from the dangers of polypharmacy tip number two is to ask the following question anytime your doctor is about to prescribe a new chronic medication not not just a short-term thing like an antibiotic for an infection but something that that for all intents and purposes you're going to be taking from now on ask this question is this medicine really necessary and again you might think well gosh that feels a bit offensive they are after all the doctor they wouldn't be prescribing this for me if they didn't think it was necessary i'll contrary this is not true at all many doctors actually have the false expectation that that you have the expectation that since you went to the doctor you want a prescription and indeed many patients do want a prescription but you are a smart patient and you know better than this and so when you ask this question you are basically loading the conversation in your favor and and in many cases you will find that the doctor says well no actually we can probably hold off on this and if you're still having this problem we'll prescribe it the next time you come in you just saved yourself a prescription medication you saved yourself a copay you saved yourself a call to the insurance company to try to get it covered and you just saved yourself from potential polypharmacy by asking this one key question tip number three is the motto start low go slow and so anytime your doctor is about to prescribe you a new medication that you anticipate you'll be taking for a while ask your doctor is this the lowest dose that that i can take is there a lower dosage of this in many cases doctors you would think they would start low and go slow but in many cases doctors are so eager to get to that therapeutic benefit that they'll start you on a much higher dosage and as you get older this becomes much much more important and potentially much more dangerous so always ask is there a lower dosage that we can start with tip number four is if you start one stop one and so if you're already on three or more medications and your doctor says hey i'm going to prescribe you this new medication ask the question okay but which one can we stop and in many cases your doctor has not considered that at all and just you asking that question very politely your doctor is going to say well i mean i don't guess you need this one anymore we'll stop that one and so you just you just traded medications instead of adding a medication to what was quickly becoming polypharmacy tip number five is every time you go to the doctor you're gonna take your big brown bag with everything in it you're gonna line them all out and you're gonna ask the following question which one of these do i no longer need which one of these can we stop now or which one of these at least can we decrease the dosage of this is a very powerful question because it's going to prime your doctor's mind that hey this patient doesn't want a handful of pills they don't want to be on uh you know the the monday through friday pill caddy that's completely full of pills they don't want that and so then your doctor will suddenly become your advocate in this regard and say well i guess you don't need this one anymore i'll stop prescribing that one you just protected yourself from polypharmacy by asking that one question tip number six is to assume that any new symptom that starts within a week or two after you've started a new medication assume that that symptom is a side effect of that new medication don't go back to your doctor and say hey i've got this new onset heartburn or this new onset insomnia i need a pill for that go back to your doctor and say hey you started me on this pill two weeks ago and i've had trouble sleeping since then or i've had heartburn since then or i've had diarrhea since then i don't want an another medication for that symptom i want you to stop for a second doctor and consider is this a side effect of the medication that you prescribed for me tip number seven very important tip is to establish a a a prescription quarterback now this can be your pharmacist at your pharmacy if you have a good relationship with them this can be your primary care doctor either your family doctor or your internist but you're going to appoint one of your learned health partners as your pill quarterback and you're going to discuss all your prescriptions with them you're going to always say hey asked all these questions all these tips especially to that one doctor but you're always going to tell your pill quarterback every single medication you're taking not just the medications that they prescribed so if you've got a medication from the endocrinologist the cardiologist the nephrologist or any other specialist your quarterback is to know about that pill immediately and so as soon as you get home from the specialist home from the pharmacy if your pharmacist is not your quarterback you're going to call your primary care doctor and say hey i just saw dr mcgillicuddy the cardiologist and he or she prescribed me the following medications add those to my chart and make sure that i'm not going to have a drug drug interaction or a new side effect from this medication or since i'm now taking this is there another medication i can stop having this quarterback and not only uh in your mind they're your quarterback uh to ke to protect you from polypharmacy but i want you to make it very clear to them you are my protection against polypharmacy then they'll put that hat on because any good doctor is going to be like well yeah i don't want you to suffer from polypharmacy i don't want you to be admitted to a nursing home when we think you're old and demented and washed up really you're just suffering from polypharmacy so yes i accept the role of quarterback i will do that for you and i will protect you from the ravages of polypharmacy far too many people are admitted to nursing homes unnecessarily every single year because of polypharmacy far too many people are admitted to the hospital because of a drug drug interaction due to polypharmacy and indeed far too many people die each and every year from the drug drug interactions caused by polypharmacy this is very important and if you have an older friend or relative who takes a handful of pills please share this video with them or write down these seven tips and go with them to their next doctor's appointment bring a brown bag with them so they can put all their medications and follow these seven tips so that they don't suffer from polypharmacy as well