Less Becomes More: Where Subtraction Has Positive Results

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I spent the weekend gardening. It’s spring, after all.

Since my last assault on my garden last Fall, many plants got leggy, or died, or just needed rehab of some sort. Unlike many of my neighbors (and maybe you, too!) what I love most about gardening is finishing it. It feels so good when it stops! 🙂

What was unique about my weekend gardening is an observation I made; a good metaphor to share with you, in hopes of providing some inspiration on a service you can provide to your clients. (Yes, this is what happens when I’m pulling weeds. I get thinking about other, more important things!)

No – I don’t expect you to do your clients’ gardening! But follow along with me and it will make sense.

Last Fall I prepped my plantings for winter. One shrub had just grown way too big for its space, so I hacked the heck out of it. I removed branches that reached too far or had leaves only on the tips, and reduced its size by almost half. (I wish I could tell you what kind of shrub it is – but I can’t remember the name. You can see it in the photo.)

This spring, for the first time, I was rewarded with some beautiful blossoms on it! We’ve never had blossoms on this shrub! While it’s difficult to see in the photo, the blossoms are a pretty lavender color, about one inch in diameter. For the first time, it’s no longer just a gold-ish colored shrub. It’s a flowering shrub!

I got thinking, as I pulled those weeds, that those blossoms were the result of SUBTRACTION. Had I not removed all those limbs, we would not have reaped the reward of flowers.

Less became more.

That’s the metaphor for a service every independent care advocate should offer to a client because for this particular service, SUBTRACTION can improve their quality of life.

It addresses a problem that is so prevalent that it even has its own name: polypharmacy.

Polypharmacy is the problem of taking so many different drugs and supplements that they, in effect, contradict each other. It occurs because doctors either don’t understand where the conflicts can occur, or because they don’t read a patient’s record carefully enough, or because a patient’s pharmaceutical record isn’t complete. Polypharmacy results in new symptoms and side-effects when the doctor prescribes a new drug that supposedly takes care of symptoms.

I first learned about polypharmacy when it caused a patient’s dementia. The patient began showing cognition problems he hadn’t experienced before, eventually traced back to drug interactions / conflicts.

The most heinous case of polypharmacy I ever heard of was a teacher who was experiencing fainting spells in her classroom, so bad that she lost her beloved teaching career. After seeing several doctors while trying to get to the bottom of it, she was eventually diagnosed with Parkinsons and was taking 41 pills a day! Seven years later, after a particularly bad fainting event, it was determined she had been misdiagnosed. By the time I interviewed her a few years after that, she was taking only 10 pills a day, and was getting ready to return to her classroom.

Polypharmacy can be simple to review, and when problems are uncovered, possibly simple to solve. Clients it applies to will be forever amazed and grateful that you raised the question and helped them review with their doctors.

How to Uncover Polypharmacy

When you discuss medications with your clients, ask for a list everything they take – and I do mean everything. “Natural” supplements are just as likely to cause conflicts and side effects as pharmaceutical drugs are. You can explain to them why you are asking – tell them about polypharmacy. They’ll be impressed that there is a word for it, and they’ll be happy to have you help them figure out if it’s a conversation to have with their doctors.

If you learn they take more than 2 or 3 drugs or supplements, then find an online drug interaction checker to help determine if there is potential for conflicts. There are several:

Now – IMPORTANT! – we are advocates and care managers, with ethical standards to uphold, and we do not perform medical work. If the results of your interaction checker research determines there is potential for a problem for your client, you will only report it to your client as a potential problem. Do not report what drugs are the guilty ones, nor should you blame any providers.

Instead explain that you’ve found a potential conflict and you would like to help your client discuss possibilities with his or her doctor – to determine if the number of drugs and supplements they take can be reduced to improve their quality of life, and possibly the impact on their wallets.

By consulting with the client’s primary care doctor first, then possibly specialists, they may determine there are drugs or supplements that can eliminated, combined, or dosages that can be reduced – all of which can have a positive impact on health and finances.

What a great service for your clients!

For some, the results may be metaphorically similar to my experience with my gold-leaf-lavender-blossom shrub! They’ll be rewarded with looking or feeling better, and you’ll be rewarded with a happy client.

 

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Comments

  1. Jackie O'Doherty  May 22, 2019

    Part of my service to is have the pharmacist periodically do a medication review. I also make sure medication reconciliation is done at every doctors appointment.

    reply
  2. Rosalie Weatherhead  May 22, 2019

    Won’t most pharmacies do a med review upon request? I think a doctor can order one if they won’t do it with a request from the patient.

    reply

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