According to Werder and Preskorn, the word polypharmacy first appeared in the medical literature in 1959 in the New England Journal of Medicine. I really wanted to find the NEJM 1959 issue but was unable to, so as far as the context of its derivation I am unsure.
It does seem that many people believe that polypharmacy is an evolving problem. Actually, some define polypharmacy in two ways: rational and irrational. They define rational polypharmacy as polypharmacy in which medications are not used to treat the same condition. For example, if you are given a certain medication that has the side effect of increasing the acidity of your stomach acid and your doctor prescribes you an antacid to help the side effect. This makes sence right? As far as their definition, the doctor would not be using more than one drug to treat the problem, but rather an extra drug to help with the side effects.
Irrational polypharmacy refers to having several medications for the same condition. An example includes having several prescribed antipsycotics. There are several theories expressed as to how this type of polypharmacy occurs. Some say it happens due to fear and laziness. A patient doing poorly, so the doctor adds another medication, and maybe it will help a little. Another theory is inappropriate diagnosis. A patient may explain a side effect and the doctor prescribe another medication when really the patient just needed a higher dose of the original.
What do you think?
I believe the main fuel to the polypharmacy problem lies within patient/physician communication. Many patients do not realize how imperative it is that they inform their physicians of their entire medical history; from their most serisous diagnosis, to the over the counter medication they are taking for allergies.
ReplyDeleteOften times I feel that patients over look telling their physicians of the little things, such as the over the counter medications they are taking, because they have the mind set of "its over they count, its safe. no big deal."
It is a big deal. Mixing chemicals is mixing chemicals; no matter what way you spin it. It is even more dangerous when you are mixing these chemicals inside your own body.
Kinda cool history lesson. Does every doctor believe there are two definitions of polypharmacy or is this just a theory?
ReplyDeleteAnd what Brian says is really true...a little more frank than the post. "Its a big deal."