Our hospital uses a Medication Reconciliation Record (MRR) to ensure that we know what medication patients are on at home. Twenty years ago this could be done by the doc asking the patient about the two or three meds they might be taking; over the years guideline – inspired and pharmaceutical company – generated prescribing has kicked in and medications have proliferated exponentially. Now to get the MRR straight we have to involve pharmacy techs, pharmacists, nurses, doctors and the provincial computerised drug database. The record has space for 10 medications per page. It is not uncommon to fill 3 pages with the medications for a single patient. How can anyone need / want / benefit from 20 or 30 medications? And we get mad at patients when they are non-compliant!
No wonder that over 10% of all emergency room visits are related to problems with prescription drugs.
We need teams of pharamaceutical surgeons to perform key operations – drugectomies, and start practicing Minimally Disruptive Medicine, a term coined by May and others in 2009.
The phenomenal Bohemian Polypharmacy is from James McCormack (copresenter of the Therapeutics Education Collaboration.) James also has another great video for wannabe drugectomists – Make it Easy