The Blindspot of a Geriatric Pharmacist

Generalizations aren’t always the greatest, but I do feel that I’ve learned a lot from my experiences. As a geriatric/ambulatory care pharmacist, I feel that we (maybe more-so me) as pharmacists do sometimes have a blindspot. Let me explain.

Throughout school and in working with a large number of polypharmacy patients, I feel like I tend to have a bias towards medications. Medications (and over-medication) tend to be the enemy of a geriatric pharmacists. Medications can and do cause lots of problems. This is without question.

What I tend to forget about is the ramifications of undertreatment. Patients go to the hospital for CHF exacerbations, strokes, COPD exacerbations, and other conditions that can be prevented or at least reduced with the aid of medications. This is something I need to remind myself on a regular basis. Medicines can truly do a lot of good.

I think physicians (again generalizing) do a better job of recognizing the risks of under-treatment (or no treatment).

Physician, NP’s, and PA’s have a heavy focus on identify problems (diagnosing) and providing a solution (often a medication). Pharmacists see the side effects, risks, drug interactions, and complications that using more medications can cause. I believe this is why pharmacists are the perfect pairing to “pump the brakes” on overly aggressive medication use from providers.

I remember a poorly written recommendation by a pharmacist (fortunately not me) where the use of tamsulosin was questioned. The patient was not having adverse effects. The physician wrote something to the effect of “taking away this drug would cause acute urinary retention and likely hospitalization”. I think this demonstrates my point perfectly. The physician is significantly worried about the exacerbation of the condition while the pharmacist is worried about complications from the drug.

What do you think? Does our training lead us down the path of worrying more about the drug than the disease?

I’ve literally written thousands of medication recommendations. I’m not perfect but have learned so much. If you are looking for more real world information on writing medication recommendations, you can check out our 3 hour course.