Wednesday, 30 March 2011

Too many tablets


Doctors today have a plethora of drugs that they can prescribe. There is indeed a pill for every ill. How different it was 100 years ago. Indeed how different it was when I qualified in 1978. Back then the British National Formulary was a small hardback book about the dimensions of a passport and about half an inch thick. Now its the size of a large paperback with over 1000 pages!

There are several 'problems' with having so many drugs to choose from. One is the obvious one of prescribing them when a better policy might have been to wait and see how a patient's symptoms  develop. Of course the counter pressure here is of the increasing medico-legal aspect of medicine which finds it hard to defend inactivity versus a more traditional watchful waiting. But prescribing does bring it's own problems.

It's thought that 30 % of collapses in the elderly are due to poylpharmacy-the prescribing of multiple drugs. These collapses may result in significant injury and even death. They may also result in injury or worse to others. And there are so many other potential adverse effects of all individual drugs that they now come with the proverbial list as long as your arm of what may adversely happen whilst taking the drug.

And all this before we get on to the subject of cost. The medicines bill for the NHS is £10 billion a year. Yep, that's ten thousand million pounds! That's about £1650 per person per year! So any careful reduction in prescribing by a GP could have massive overall cost implications.

Polypharmacy is a real problem. With pressure from illness groups to defend their own turf and facilitate prescribing for their chosen condition, it leaves the GP in the middle trying to think through the impact of several drugs being taken all by the same patient. In other words we fall back on the Hippocratic principle of first do no harm. Something not easily appreciated by others, but something that our current economic position will encourage us to do.

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