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The Pill Trap
Please excuse the ramble of this post; things are still a bit fresh. My mom died this past weekend at the age of 75, and she was an old 75. Her health had been impaired since she survived an aneurysm (it didn’t burst) more than 20 years ago. Since then, she’s been on a host of medicines prescribed by a host of doctors for her ever-mounting medical issues. But I didn’t have a full appreciation of the pill trap she was in until this week.
To be certain, my mom didn’t do much to help her health situation. Her diet was horrible. She didn’t really exercise. She was a homebody. And on. And on.
However, as we, her children, cleaned out her house, we found scores of pill bottles that still had medicine in them. (I should put scare quotes around the word medicine.) We collected the pills for proper disposal, and they filled a gallon ziplock bag to the brim like a bizarre bit of sand artwork. It was my job to clean out the room where she kept all of her paperwork. I found a few hundred prescription refill notifications – each with two pages of patient information and three to five pages of drug side effects and interactions. The volume of paper wasted to cover butts (legally speaking) is astounding, especially since they’re almost certainly rarely read.
Indeed, I find it impossible to believe that any one of my mom’s doctors really understood how all of the drugs she was put on really interacted or the long-term consequences of her being on those drugs. She certainly didn’t and couldn’t. And she was on some for a very long time. (I won’t get into the list of drugs she was on, but we’re not talking baby aspirin here.). And what did all of those do for her? I don’t know. But I think it’s reasonable to think that in the long term, they were detrimental to her health. I can’t imagine it being any other way.
All of that is not to say that had she not been on so many medications she would not only be alive but healthy. I’m not so naive as to believe that. But I can’t imagine they really added life to her years. They were, the pills were, the easy answer for doctors to give. And the easy answers for Mom to follow, at least in theory. They were easy until they took over her life and the living of it. Then she was a slave to them.
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I hope the physicians here will chime in but it’s common for us to get a bag full of pill bottles when we transport a patient. It’s usually easier to grab the bottles and take them to the ER so it’s clear what they have been taking. (The alternative is to take a picture, technically a HIPAA violation). I’m not sure how multiple physicians can reliably deconflict drugs. We had one patient (a frequent flier) in her early 70’s who purposely used multiple doctors to obtain opioids. Eventually she had alienated all of her family members and friends. She ended up being found in her home a week after she passed.
That having been said, I recently saw my PCP for a small issue and they knew all of the prescription eyedrops I had been taking after cataract surgery and asked me about each one. So at least some of the systems are working.
We saw that build up of meds with parents. A large(r?) issue is how well older and infirm or weak or otherwise compromised people faithfully follow the directions for the meds. Eat with or without food, drink a full glass of water, take Xtimes a day, no alcohol, etc….. Finding full bags/bottles suggests someone wasn’t taking them and who know whether they got any benefit.
I am so sorry for your loss.
I understand your frustration with the health care system. It is hard for anyone, especially those who trust that the doctors have the answers, to know if the medications they are prescribed are actually helpful or are interacting in a way that makes things worse.
True. And each new reason a doctor is seen results in 1 or more new medications with specific instructions (see @EODmom’s comment). It’s a spiral (descending, I think).
I too am sorry for your loss. That is always hard. My mother-in-law was also on a dozen meds when she passed at 83, some were long term. I thought that also was excessive and her lifestyle mimicked your mom so I guess she lasted longer and beat the odds. She was also diabetic and ate sweets!
I remember during my property management days a customer asked me to go back to their house and find her husband’s meds and ship to him so I did. He barely shuffled when he walked and I never asked what his ailment was. His wife was extremely fit. I found the meds. They filled a large duffle bag!!! It cost over 90 dollars to ship overnight! I thought it was horrible that this poor man was on so many meds and surely these doctors had no clue. The interactions alone !! He did pass from cancer I heard.
I don’t think docs communicate and there should be a database where they can review what the patient is taking and for what. You also can’t rely on the elderly to remember.
I cannot imagine that European medicine is like that. I know it is socialized but I think they live a healthier lifestyle and eat fresh foods……….
This is true. When I was working, I’d have patients on grocery bags full of meds. “I have to take this medicine because I take this medicine that causes X.” I’d ask if all their docs were aware of what meds they were on. Most would shrug and say they didn’t know. Heck, most had no clue why they were taking certain things. They’d just been on them for years. The computer should be a help in this matter, but it’s not. Lists aren’t cleaned up properly and some docs don’t really look at it (for that reason, I’m sure). The best think we could do, for a host of reasons, is to stop the pharmaceutical industry from advertising. Sometimes you can’t just take a pill or a shot to fix your ailment.
I am sorry for your loss, @flapjack.
Yes – if advertising alone for meds on TV were eliminated, you’d actually get more than 15 minutes viewing before more commercials!
This was the promise of Electronic Medial Records funded under Obama to the tune of $Billions$! After years of broken promises and web technology that functions intermittently, it does work sometimes.
I usually get my health care through the VA at a military hospital. They referred me to a specialist downtown who requested bloodwork. I asked if he could access the test results from the previous weeks test (at the military hospital), but that would have taken a week or more. The lesson: Even the government’s preferred local provider can’t access government health records, even though they both have “electronic medical records.”
My mom was on ten medications when she died. I was really good friends with her pharmacist because of my worries about the interactions among the various drugs. Her pharmacist told me that CVS is set up to flag interactions for the pharmacist, and her pharmacist looked them over too.
But that was ten years ago. I doubt very much that the pharmacists I’ve met these days care one whit about the patients. They have so many. It’s just a mechanical operation.
I have no answers. I don’t know how the doctors themselves keep track of the prescription medicines and their efficacies and interactions.
I’m sorry that you’ve lost your mom. Please know you have my prayers and sympathies.
My 90 year old mother has a number of pills she has to take. I’m the one who checks the interactions and questions the doctors. WebMD has a medicine interaction checker, as do other good medical websites. I have found when a patient has multiple doctors, most doctors focus on their specialty and give little consideration to issues of other specialties. I think they first just try their medicine and let the patient come back if they an issue comes up. A patient has to be on top of doctors all the time. You are one of a number and disappear from thought once you leave the office.
CVS still flags interactions, but they have to be strong interactions. I have found there are less than strong interactions that might effect some and not others that go under the radar.
To add to that, I’d also recommend you check WebMD, or another solid medical site, for side effects of all your medicines. Keep a list and note if any pop up, whether you can manage the side effects, and then relay it to the doctor.
First, my sincere condolences on your loss. May her memory be eternal.
My mom passed away just before she hit 70 and had a similar mess of pills lying around. I wonder if it was a generational thing. If a doctor said she should take a certain drug, well, he was the expert, so she wouldn’t push back.
In her last days of in-home hospice care, we went through her dresser, which was full of 60 different prescriptions. Who knows how many she actually took day-to-day, but they conflicted with each other.
Rx #1 lowers my blood pressure but gives me dry-mouth, Rx #2 relieves the dry-mouth but keeps me up all night, Rx #3 helps me sleep but gives me vertigo, Rx #4 relieves the vertigo but raises my blood pressure. Start that merry-go-round at 45, and 20 years later, you’ve got 60 prescriptions.
Yes, CVS still flags drug interactions. They have counseled me a number of times lately when things I’ve needed on a temp basis have interactions with my regular meds. I appreciate it, but my docs do the same. They all review my med list at every visit. When my Dad died my siblings and I found dozens of bottles ftTramadol , full and unused . he had felt they didn’t do anything for his pain but never discontinued them.
Condolences on your loss.
As for the rest:
Many people don’t realize how blood chemistry can change as we age – and it makes a big difference in all kinds of reactions. And many people are unwilling to disclose intimate things (like maybe having just a little incontinence or diarrhea maybe? Or feeling dizzy and tripping one or two times last week) to yet another new doctor they don’t know. Or they don’t want to make an appointment and go through the demands of going to the doc or the clinic or wherever.
My in-laws were Kaiser members and the effort to get the appt., get to the complex, park, get to the right floor and checked in was a lot of work. She never wanted to ask for me to drive her and my father-in-law. So we had to be very conscious and persistent in knowing what was what without being impertinent. It was a delicate balance. I heard “I didn’t want to bother you.” A lot for awhile.
This is one of the times it’s advantageous to keep your medical interactions–as much as possible–within “network.” Pittsburgh has two highly competitive healthcare systems, University of Pittsburgh Medical Center (UPMC) and Highmark, each of which has its own insurance plans and “network” requirements. My community hospital (which has entered into negotiations to merge into the UPMC system) always played pretty well with both. But my insurance is from UPMC, which recognizes my hospital and family doctor clinics as in-network, and (fortunately for me) also includes several world-class larger hospitals, trauma centers, and clinics within the same network.
In 1995, my community hospital started implementing an electronic medical records system (EMR) across all its owned doctor practices (its own network of family practitioners and a number of specialty clinics). I was the person in the hospital’s IT department with overall responsibility for getting it done, which is why I’m writing this comment. Such systems include drug-interaction and allergy flags, so that when a patient is assigned a medication that interacts with something else they’re on, or to which they might be allergic, the physician is immediately notified. Before such systems were fully integrated hospital-wide, or into departments like emergency medicine, connections and subscriptions to websites like UpToDate achieved a similar function with a bit more overhead; I am sure there are many more now, even as I’m sure that most reputable health care networks have the software in-house to do the work for them upfront.
I have also identified a single pharmacy as my pharmacy of choice for prescription fulfillment. That pharmacy gets all my prescriptions electronically from all my doctors. They have their own filtering, allergy, and interaction software, and they’ll pick up a problem if there is one. (I’ve had this happen once. The pharmacy phoned the doctor’s office, and by the time I got there to see if the prescription was ready, it had been changed to something else.)
There is–perhaps–a cost penalty for doing it this way. Years ago, when I had a diabetic dog who required insulin shots every day, I pharmacy-shopped to find the cheapest price for the same medicine every few months. But, even though convenience comes with a price, I think the added benefits for my own peace of mind are worth it.
There are other insurers in the Pittsburgh area, and I can’t speak to their efficiency or value. My general impression, though, is that their care isn’t so tightly integrated, and you’re not so likely to get the call–as I sometimes do–from the woman I call the “UPMC Bother Lady” informing me that I’ve an overdue prescription, or that it’s time for my annual mammogram, or asking me why I haven’t renewed a medication which–if I’d been taking it diligently–should have run out ten days ago. Those exist because of the tight “network” coordination, and I suppose I’m grateful for it. 😬
If you’ve a loved one, particularly an elderly and susceptible loved one, in need of a great deal of medical care and with a number of puzzling medication bottles, I’d suggest starting at the family doctor level and finding out how such things are tracked, and following through to the end. These days, and if you’re careful, the safeguards are in place.
If it was not for pills, people would live much shorter lives. I have plenty of friends who keeled over from heart attacks between 35 and 55. Blood pressure and cholesterol have to be managed.
Too much of anything is bad – that is found in the tautological meaning of “too much.” But it is not, on its face, obvious that people should not be taking drugs to improve their wellbeing and longevity. Nature does not have any desire to keep us alive.