IS A PATIENT EVER TOO ILL FOR MEDICINE?

Main Menu | News By Date | News By Supplier | News By Category | About Us

IS A PATIENT EVER TOO ILL FOR MEDICINE?
26 June 2007 - University of Chicago

According to medical guidelines, the patient had high cholesterol and should have been taking a drug to lower it. But her doctor didn't write a prescription. The drug was unlikely to help someone who was 100 years old and had advanced cancer. It wasn't worth the cost, side effects and hassle of taking yet another pill.

The patient was treated by a colleague of Dr. Holly Holmes of the University of Chicago. The case, Holmes said, illustrates how patients reach a point in their lives when some drugs offer so few benefits they should be discontinued.

In an article in the Archives of Internal Medicine, Holmes and colleagues offer a framework for deciding when to discontinue drugs for patients who are very old or very sick.

Doctors should take into account the patient's life expectancy and whether the drug is likely to provide much benefit in the months or years the patient has remaining.

Doctors also should consider when it's time to stop trying to cure a terminally ill patient and instead prescribe only those drugs that relieve pain and other discomfort.

Researchers offer several case examples.

One case involves a 75-year-old woman with high blood pressure, high cholesterol, arthritis and diabetes. With a remaining life expectancy of 17 years, it makes sense to keep taking drugs to treat those conditions, researchers wrote.

But in the case of a 72-year-old man with congestive heart failure, emphysema and a six-month life expectancy, the doctor should stop prescribing drugs intended to provide long-term benefits.

Happy to give up their pills
Elderly Americans who live independently typically take three or four prescription drugs a day. Nursing home residents typically take seven or eight prescriptions.

Studies have found that patients who take at least five prescriptions have a 90 percent chance of suffering side effects or complications from drug interactions. About one out of five elderly patients takes a drug that has a high risk and low benefit, Holmes said.

Nevertheless, 65 percent of all office visits end with the doctor writing a prescription. 'It makes us feel good to hand something to a patient,' Holmes said.

Patients are bombarded with drug ads, and have been told for years about the importance of taking their medicine. So doctors might be reluctant to discontinue their prescriptions.

But it turns out that many patients are happy to give up their pills. In a 2001 study in the journal Family Practice, 272 patients were surveyed after their doctors discontinued long-term drug therapy. Seventy-three percent said they were satisfied or very satisfied with the decision.

'There's a misperception that patients don't want us to take their medications away,' Holmes said.

http://www-uchicago.edu

About: University of Chicago
The University of Chicago was founded in 1890 by the American Baptist Education Society and oil magnate John D. Rockefeller. The land for the new university, in the recently annexed suburb of Hyde Park, was donated by Marshall Field, owner of the Chicago department store that bears his name.

In 1929, Robert Hutchins became the University's fifth president. During his tenure, Hutchins established many of the undergraduate curricular innovations that the University is known for today. These included a curriculum dedicated specifically to interdisciplinary education, comprehensive examinations instead of course grades, courses focused on the study of original documents and classic works, and an emphasis on discussion, rather than lectures.

During the late 1950s and early 1960s, the University began to add modern buildings to the formerly all-Gothic campus.

More News:
  • For June 2007
  • From University of Chicago
  • For University