Making a 'Very Bold Statement' to Physicians
A large part of my current position involves reducing the risk of falling for people in the community as well as those residing in care homes. That's what prevention is all about -- reducing risk. Not long ago, I received a phone call from an irate physician who took offense that a mere physiotherapist would write him a letter detailing which medications were potential culprits in the patient's falling.
"Are you implying I don't know my own patient's medications?"
"No sir, but we find it helpful to remind GPs of how many culprit medications a person may be taking."
"You're saying I don't know that?"
"Not you personally, sir, but I have had some GPs in the past who were not as well versed in a patient's current regimen."
"That is a very bold statement, sir!"
We discussed a little further and then discovered that indeed he had forgotten the patient was still on one particularly troublesome medication. Bold. Indeed.
To give GPs a break, they have precious little time to sit with older adults and figure out exactly what meds they should and should not be taking. Because there is such evidence that blood pressure medications reduce the risk of heart attack, stroke, and kidney disease, nearly every older person is on at least one such medication.
Mary E. Tinetti, MD, just published an article in JAMA about the risks created by these very medicines. We now have excellent evidence that these medications are not merely innocuous, but rather can affect a large number of people in disastrous ways.
So which risk do we try to reduce? Use the medications and run the risk of a debilitating fall and/or fracture? Don't use the medications and run the risk of heart attack or stroke?
Prevention, like every other aspect of healthcare, is not a simple black-and-white situation.