Doc, I need more drugs man.

03/19/2009 at 6:57 AM Leave a comment

In contrast to the post about the patients “not believing in medicine” there are many who believe all too much. In this case it is no surprise they come to me, after all we are the keeper of the medicines. Like the famous bank robber asked why he robbed banks replied, “that’s where the money is.”

It requires a very different skill set to manage these patients. They are all too eager to get the next great pill that will fix all their problems ( real or not). They do not get ( or at least do not complain) of side effects, they don’t worry about interactions, they don’t complain of costs or of complicated medical regimens. They may know what symptoms they need to get the next great pill.

In some ways they can become our greatest patients, compliant, pleasant, grateful. Yet at some point I will look at the med list and have a sense of discord. The number of medicines do not match the health of the patient.  Many times it isn’t any one doctor that prescribes the meds. It is a collection of specialists and primary docs. Sometimes it is not even clear to us that they are taking so many medicines, since they may not want us to know. I can usually understand how each medicine in isolation was prescribed but it is when I look at the big picture that something does not sit right.

Yet the patient is not complaining and is insisting that every one of the pills helps her immensely. It is a conundrum that I can only deal in a case by case basis.  I am most effective when I have known the patient for  a long time  and have a built in amount of good will and trust.

The first and most important step is to stop adding medications. This is much harder than it looks. The next step is to decrease doses of other medicines, combine medicines or come up with ways of getting a two-fer. That is a medicine that will at some level treat two different complaints. 

If I feel it necessary to add a new medicine, I will only do so if they will drop one of the others.

This isn’t Munchausen’s  but it must be a  relative, a milder, gentler relative but a relative nevertheless.

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