Drowning In Pills

A lot of people are on a lot of tablets. And whilst that might sound like a colourful pick-and-mix panacea, being on 10 or more medicines can - bizarrely - start to cause problems. Medicines can interact with each other, reduce each other's effectiveness, or there may be a accumulative of side effects (e.g. dizziness, or low blood pressure). They can even cause confusion or memory problems. This is most definitely the opposite of 'better together', and we call it 'polypharmacy'.

Hang on though, what if someone has multiple conditions, like an underactive thyroid, a previous stroke, diabetes, and chronic pain? That's almost certainly going to mean 10+ medicines isn't it? Absolutely, sometimes many medicines are necessary, so we can still do our best to ensure there's a review annually to check everything still works, and important blood tests (such as salt levels and anaemia), are performed. And, we try to ensure that between hospital clinics and the GP, no sneaky changes have been made that might e.g. increase the person's risk of falls, constipation, or drowsiness.

Added to the automatic SMS or email reminders or the message you may see on the white side of your prescription, we rely hugely on community nurses, carers and family members to let us know if there are issues with medications. A classic example is stockpiling of items the person no longer wants, has difficulties taking, or already has a large supply of. Unfortunately we often find hoards of unopened medicines in bags or cupboards, and unpicking how this has happened has to be done delicately. Hence the video above (credit to 'The Sound Of My Music' on YouTube for the backing track), as a plea to people to not keep ordering "everything on the list please".

Which brings me to the concept of deprescribing, where we try to safely and carefully reduce the number of medicines on someone's list - after a conversation with the patient and their carers. Be reassured that we would never remove something that is clinically essential, such as insulin or thyroxine or daily inhalers, and we do try really hard to review everyone's medicines annually. Remember evidence and research changes and improves over time, meaning the aspirin you were told to take when diagnosed with diabetes in the 1980s, may not necessarily be the most appropriate treatment for you nowadays.

Holistic care (considering the whole person; their routine and lifestyle and relationships), i.e. the bedrock of what we GPs do every day, is at risk in the current climate. And for once I'm not talking about the global warming (though obviously that is relevant to everything, ahem!), but the chronic underfunding and understaffing of community healthcare. You'll probably know that 90% of all healthcare takes place in...^drumroll please^...yes, the community. But how much of the fiscal pie do we receive? You don't need 3 guesses to come up with the correct figure of <10%. I smell something disturbingly disproportionate. So it's no secret that we're also trying to economise wherever possible. And yes that includes no longer prescribing antihistamines and paracetamol routinely, for many people (there are exceptions) when they are available cheaply over the counter.

In fact economical healthcare is one of the 4 pillars of ensuring the NHS remains sustainable: fit for the future. And we have to spread this message to every corner of the organisation from management all the way through to staff and patients. We may need to get a little more creative and exciting with our messaging, hence why I make videos such as the one above, and in a workshop I'm running today at York St John University, the format will be an 'escape room in an envelope', with games based on popular brands such as The Traitors, and Top Trumps. Hopefully this is a fun way to share and spread the information about appropriate prescribing.

Medicines have a place in keeping people well, both in the short- and long-term. Help us to keep them working, avoid them being wasted, and remain affordable for everyone, by thinking before you click (watch the video above or this phrase is probably meaningless!), only ordering what you need, and booking or attending an annual medicine review with a healthcare professional.

And finally, some good news about blister pack recycling boxes, which are set to continue at Old School Medical Practice for a little while longer, thanks to generous funding from Copmanthorpe and Askham Richard parish councils! More about that very soon...