Good + Good + Good = Bad? Recognizing the Harms of Polypharmacy


This month, Dr Roger Ladouceur writes in the Canadian Family Physician (CFP) about a 65 year old patient of his with many co-morbidities. He treated her with guideline-based care, resulting in her taking 16 medications and perhaps, as he solemnly suggests, in someone's death.

Not hers.

We will never know, but polypharmacy may have been a factor in why her vehicle careened across the median and struck a pedestrian who was crossing the street, eventually killing him.

It is noble of Dr. Ladouceur to draw attention to this case; it takes a brave person to consider error, reflect meaningfully, and to move forward with purpose. Trying to help this woman achieve health is not a "mistake" by any means, however with the opportunity to take a step back, he saw that in trying to help her, he may have caused harm.

Good intentions are essential to providing good care, but with everything we do, we may cause harm. Polypharmacy is a perfect example of how evidence and guidelines can compound to create an untenable state. As he writes:

I am not the only physician to prescribe so many medications; most of us often prescribe a substantial number. This is not about assigning blame; we are following the recommendations. Each medication is justified for the indication for which it is prescribed. But what happens when they are all taken together, even when there are no drug interactions?
Could it be that, for a man who went for a walk after breakfast, prescribing 16 medications was fatal? Could it be that, sometimes, we do too much?

Read the very thoughtful article here.