As we age, among all the more visible changes, can come the body’s unwillingness to accept the same dosages of some medications. We can become more sensitive and reactive than we were in our gravy days. Geriatricians, the medical doctors who specialize in treating seniors, know and respect the fact that an older body has probably geared down (or even gotten stuck in neutral) and requires fewer or different drugs.
Your best friend can turn out to be your pharmacist. Because we now see so many different specialists and can be prescribed lots of interventions by lots of different people, our pharmacist may be the only person who gets to see the entire spectrum all in one place. A local pharmacist called an acquaintance of mine to say “I am reluctant to fill your most recent prescription. Does your doctor know that it interacts negatively with your other medications?” Usually, the pharmacist calls the doctor directly, but in this case started with the patient. The patient then called her doctor’s office and the nurse responded, “The doctor ordered it. So that is what you have to take.” Not a good answer.
Wilmington’s town nurse Jennifer Fitzgerald, working with the Blueprint for Health at Brattleboro Hospital, tells of a meeting with a group of area pharmacists and prescribers where she asked for a show of hands
“Have you had trouble getting to speak directly pharmacist to prescriber, or are questions answered by someone else in the office?” Many of the hands went up.
The current standard of care is that at every doctor’s appointment the patient is asked to review the list of medications and supplements they take and update the list if there have been changes. The next question might be, “Have you seen a new doctor recently?” As you might expect, some folks say, “Oh, yeah, I forgot about that, and he/she added a new medication for me which is not on that list.” Here in southern Vermont we border three other states. Patients can be seeing doctors, orthopedists, dentists, ER docs, and eye specialists beyond the local area primary care offices. The laws from vary state to state, especially with pain medications. A patient could have prescriptions for more medication or ones that interact adversely and no one but the pharmacist will see it.
A contemporary of mine living in another state was recently moved from her home to an assisted living facility in yet another state to be nearer her family. She struggles with both dementia and bipolar depression for which she takes lithium. Her primary care doctor in her home state put her on a diuretic just before the transfer. I doubt he checked with her psychiatrist since people on lithium do not take diuretics unless biweekly blood tests are ordered as well. After two weeks in the new setting and before her scheduled appointment with the new psychiatrist, she suffered a complete collapse and was sent to the hospital unable to move her legs or arms. She was suffering from lithium toxicity and is now in a rehab facility working on getting her arms and legs strong again. This was a terrifying experience for her and for her family.
In today’s very sophisticated and complicated world, we have to start to become better consumers of health care services. Ultimately, it is on us, not the system. We have to pay attention, get educated about risks, and stay alert. Whose life is it, after all?