If It’s Not Broke, Don’t Fix It – Defining Polypharmacy

I appreciate all of your comments on the site!  An engaging, interprofessional audience really helps enhance the learning environment.  I recently received this comment on a recent diabetes med list review I posted: via Leo Lawless – “While the comment on the dosing schedule for Actos and Oxybutynin are valid we need keep in mind that manufacturers recommended dosing schedules are not a bible and we are treating people and need look at their individual response to a varied schedule. If its not broken don’t try to fix it,”  The comment is very thoughtful and absolutely true as well, and there is no textbook on how to manage patients’ medications because there a literally hundreds to thousands of variables that can affect medication management.  For me personally, I’m going to lean in and attempt to investigate how and why this patient ended up on twice daily Actos and Ditropan patch once weekly.  If the primary provider has no idea (or can’t remember), and the patient doesn’t know why either, I’m in the camp that is probably going to attempt to take some risk to reduce medication burden by consolidating the Actos (pioglitazone), monitoring blood sugars as well as closely assess the patient’s urinary symptoms and recommend a trial hold of the Ditropan patch to minimize anticholinergic burden going forward.  If the patient is adamant that the medications are working well, well tolerated, and have improved their diabetes, urinary symptoms, and overall well being, of course I wouldn’t suggest any changes.

I wanted to use this comment to demonstrate that it can be challenging to address medication related problems, and even more challenging to address them when everything is going fine with our patients.  I believe the “If It’s Not Broke, Don’t Fix It” philosophy is one of the major culprits that leads to polypharmacy.  At what point does too many medications actually become “too many medications”?  If the patient is on 52 medications is that too many?  If they feel perfectly fine on 52 medications and are doing well should we not reduce or change anything?  If a patient is on two medications that do the same thing, but are doing fine should we leave it alone?  Every patient brings a whole set of new circumstances that has to be considered.  “What is polypharmacy?” depends upon the provider, depends upon the patient, and is a question that each healthcare professional has to find a comfort level with.

For me, I work primarily in geriatrics and when I hear, “if it’s not broke, don’t fix it” – I can feel polypharmacy creeping in.  It’s a mindset that is easy to have, but I do not believe it is the best mindset for the majority of my patients.  – Notice how I said “majority” – not all 🙂

Healthcare professionals disagree, and I would make that argument that if there is no disagreement, there’s no critical thinking happening.  I have had the unique opportunity to make recommendations to well over 100+ different providers/healthcare professionals and while I feel I do my job in a consistent manner, there are providers that agree with nearly everything I suggest, and there are providers that disagree with many of my recommendations, and I’m ok with that.  What’s your philosophy?

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6 Comments

  1. Mary Sheehan

    When I clicked on it, I thought the article was going to be about keeping people OFF of medications because they aren’t broken or there is really no illness present. It’s like how we give meds to people who may be fine without them under the name of “preventative medicine.” You have presented another way to look at this phrase. Very well said. I used to work in geriatrics and now in retail. We are still over medicating our patients I am afraid but to your point- which ones? How are going to find out? It starts with intention I suppose. Anyway, great article.

    Reply
    • chri1599

      That is the daily challenge…which meds to DC and which ones to keep?!?! – Thanks for your comment!

      Reply
  2. Mary Scott

    Having working in LTC for many years, it always made me laugh when I made a recommendation to a physician about discontinuing a med and they disagreed but, lo and behold, it was dc’ed 2 months later

    Reply
    • chri1599

      sometimes it takes a little while to process information 🙂

      Reply
      • Andrew

        Totally agree.. I do EMTM with patients often on 20-30 pkus medictions. The if its not broke dont fix it attitude has ground to stand on but we also want to help PREVENT errors. Because someone is tolerating lorazepam fine fir anxiety and has no ssri or anything, doesnt mean we shouldnt try to get them on a safer medication. My goal is to reduce healthcare spend.
        And the amount of vitamins and supplements some are on arent needed and increase cost for the patient. One area intend to leave alone is compkex psych pts that are stable on their regimen.

        Reply
  3. Andrew

    Also, pts may be on DAPT and be ok but what happens with a GI bleed? At the time they may be fine.

    Reply

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Written By Eric Christianson

August 3, 2014

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