June 18, 2015

Doctors Need to Learn When to Stop a Medication

Being in the age range for geriatrics, this blog really hit home and means that I will need to pay attention to what the doctors say and be alert to any new medications prescribed to avoid duplication. I will also need to be more alert as I age to question my doctors about what medications may no longer be necessary.

This will be difficult for the doctor and me. This is because the blankety blank researchers are afraid of the elderly and multiple conditions, exclude us from clinical trials because they have no experience with us, and feel it is a waste of money to have clinical trials that might include us. Yet they will waste more money on faulty clinical trials of no meaning and think they are doing things of importance.

The blog from GeriPal - Geriatrics and Palliative Care Blog talks about when to stop medications in people with advanced dementia. The author talks about her training and says, “Throughout medical training, we devote extensive time learning when to start medications. We memorize the pharmacology, indications for use, side effects, and sentinel trials showing their efficacy. Yet, not until my fellowship training in Geriatrics, did I learn another key part of medication prescribing: when to stop.”

Why are many patients with advanced dementia still taking medications of questionable benefit? Stopping a medication may seem straightforward, and clinicians know that stopping a medication is frequently more difficult than starting a medication. Clinicians generally lack the knowledge and more importantly, the evidence to help clinicians know when to discontinue medications.

Stopping medications involves discussing the risks and benefits with the patients and their families, which if often difficult as they are of the opinion and hope that the medication will stop or significantly slow the progression of the disease. They often will not accept the disease has advanced beyond the point where medication is helpful.

Many clinicians are uncomfortable taking away medications, as they are trained to always 'do' something, which usually prescribing. Stopping medications does not mean they stop caring for the patient, they shift their focus of what the patient needs.
This means for a patient, a focus is made on hand-feeding and skin care, quality time spent with his or her family, and focus on activities the patient still enjoys. The author concludes by stating that learning and studying when to stop medications, can help us start taking better care of our patients.

While this is redundant, I would like to refer you back to my last blog and the blog by Leslie Kernisan, MD, and how she handles stopping or reducing medications for treating hypertension. Dr. Kernisan's procedure can easily be adapted to other medications.

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