I've learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into doctor prescribing habits. Often it is my job to decide with meds are necessary and covered by hospice, which are necessary but not covered by hospice, and which are useless.
Do you have any idea how many useless and often harmful meds our patients are on? I'm not just talking about end of life, but healthy patients to.
Can we talk multivitamins? Almost every patient I encounter is prescribed a multivitamin. Healthy, unhealthy, living, dying. When your in the grasps of stage five thousand and one lung cancer and your brain is riddled with mets, you have no business being on a multi. It's not going to help you. It's not going to provide that last bit of energy to overcome the calamitous collapse that is approaching rapidly. In fact, there is plenty of data to suggest multivitamins are harmful if not neutral at best. Even in healthy people.
How about Vitamin D? I swear to g-d, every patient I encounter is on some sort of D supplement. Never mind that the vast majority of medical evidence implies that supplementation is unhelpful in most disease processes. Yes, there is osteoporosis, but otherwise, it is a non starter.
Aricept in patients who don't walk, don't talk, and barely interact with the world around them? Again, started often because there is no other treatment, profound dementia patients are submitted to a host of side effects including diarrhea and syncope without the faintest glimpse of medical benefit.
Vitamin C, Vitamin E, Calcium?
How about statins in patients without a history of coronary disease with end stage-opathies and malignant cancers. Do we really think we are going to cut down on cardiac events in the fleeting few months that these patients have to live? Is there any data to support this? You better believe that these patients get myalgia and other side effects.
Antibiotics for foul smelling urine, screening urine cultures without symptoms, or agitation in an already agitated patient. It seems that treating non-utis has become the national past time of our healthcare system.
I could go on and on. Don't even get me started on antibacterials for non bacterial infections.
The point is, we are not being careful with our prescribing habits. We are not taking into consideration the wealth of evidence and data regarding some of these treatments.
And we are not being good advocates.
We are not shielding our patients from harm.
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Thank you so much for saying this, it is what we woke up to about 5-6 years ago. Our daughter has Mito and a Mast cell disorder. When we argued that this med or that caused other symptoms they encouraged her to take various meds anyway, even when it lead to taking another and another and another to treat the new symptoms caused by the medications. We had to realize that sometimes a little bit of suffering today might prevent even more tomorrow. Now, I know there are necessary medicines, and I am grateful we have medications, but I think it is outrageous how many medications the average American takes, and I feel strongly that vitamins and supplements are medications. Add to that all the OTC medications available it is no wonder so much of our incomes go to "healthcare." It is funny when we take her for annual follow up(neurology, nephrology etc) when they see she isn't taking meds nor interested unless deemed essential or life saving and cause no further progression ,they too often ask "so then why are you here today?" If you haven't heard of them already, there are is a growing group of Drs. developing a "Less is More" approach. I believe it started in Canada.
ReplyDeleteDr Grumet, do you know the hate and backlash we get when we try to get care by evidence based medicine? I mean not just from some doctors (not all) but also administration when we ask for it.
ReplyDeleteIt costs them money and they know that patients like me, who do medical research, etc. are going to catch these things.
Dr Grumet,
ReplyDeleteHere I am after reading the 5 Moments excerpt on HuffPost, then on to Amazon.com for your book, then 'In My Humble Opinion." I'm sure that you have heard it before, but you are a great writer that directly hit my exposed nerves, you know, the emotions that I have struggled over a lifetime, to surpress and forget...
Thanks
Well said. There is so much waste and misery built-in to the system.
ReplyDelete