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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Written By Eric Christianson

August 3, 2014

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