Tuesday, November 18, 2008
Asking questions can prevent polypharmacy - too many drugs - for elderly parent
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi: Why does my mother have so many pills?
I went over to visit her yesterday and she had a bag full of prescriptions and other stuff she takes, and I don't know half of what these pills are for.
She goes to this doctor and the other almost all the time, and it seems like they just add more pills with every visit. Who's keeping an eye on this stuff? Do doctors talk to each other about their patients and what they give them? How do we know if they all are working for or against her? Who is supposed to be checking this?
-- Roanoke
You raise a great question and a very important part of modern geriatric practice.
In an age where patients tend to go to multiple doctors for multiple problems, all too often the vital aspect of medication oversight does not get the attention it deserves.
The situation is called "polypharmacy" and it really means "too many drugs." I have seen studies where polypharmacy is responsible for up to a third of hospital admissions and can be a significant cause of avoidable death.
It seems to me that it is the responsibility of every provider -- no matter what their respective specialty may be -- who cares for your mother to take a proactive role in assuring that the medications a patient receives are safe and do not interact with each other in a dangerous way.
In doing this work as long as I have, I know first-hand its vital importance and I must say that I am very proud of what the Carilion Clinic has done in this vein with the revamping of its computers to the Epic system and the safeguards this new system brings to patient care. It allows multiple providers to see the interventions of their colleagues as part of an ongoing medical record so problems can be identified quickly and information shared appropriately.
Also, whenever a patient is seen in the Center for Healthy Aging, medication review and reconciliation is part of every patient encounter, and that provides an important safety net to the patient.
What I would encourage you to do is to write down each drug your mother takes and the name of the provider who prescribed it and go with her to the next doctor visit.
Question what the drug is, what it does and is it safe. Include all over-the-counter preparations as these, too, can interact with prescription drugs. Next, ask what specific disease or condition the drug is being used to treat and is it really needed and what you should look out for in case there is a side effect or toxic reaction. Finally find out how long the drug is intended to be used and what to do if mom gets sick with a different disease from the one she is taking the drug for.
By the way, this is roughly the same process your provider runs through when reviewing a medication list!
Many times families have said to me that to do this would be looked upon as "meddling" on their part or being too "forward" or offend the provider. Let me say here and now that if you did this and it saved my patient from a foreseeable medical error and protect my patient and your loved one from harm, I say bless you for being proactive.
All the providers I know feel the same way, so don't be shy. I can't tell you how frustrating it is for me when a patient winds up in the emergency room with a drug interaction or side effect that could have been prevented, and it could be if EVERYONE makes polypharmacy a priority.
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. His columns run on the third Tuesday of each month. If you have questions for Camardi, mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to extra@roanoke.com with "Age Matters" in the subject line.
