It has become an unwritten rule that most patients who visit the Emergency department are to leave with a prescription. That is how emergency physicians practice defensive medicine. For instance, physicians rarely incur a lawsuits from prescribing antibiotics. Omission of any medication appears negligent. Therefore, temptation exists in treating most ear, nose and throat infections with antibiotics that are often unnecessary. In addition, the general perception is the doctor who prescribes the antibiotic is the better doctor than those who do not. When patients fail to receive “necessary prescriptions” from their personal doctor, they may obtain a second opinion from the EM physician and leave with a prescription. Strongly ingrained from early on is that medication makes us feel better.
Are all these medications’ necessary?
A recent study posted online in the journal Health Affair noted that over half of older Americans are taking four or more medications while roughly one-quarter of seniors in other countries take these many prescriptions.[i] Clearly, Americans have become more exceptional when it comes to taking medication in order to perhaps feel better. “Happy pills” that tend to be overused are narcotics, antidepressants and sleeping pills. These medication were intended for short-term use and as a stop gap measure until other therapeutics and coping strategies could be initiated. Health maintenance seems to gravitate to taking medication rather than disease prevention through lifestyle changes.
Does this medication have side effects?
Any television commercial that advertises a prescription medication will rattle off a list of potential side effects. All medication has inherent unknowns for any given patient. Medications that initially appears to be the next best thing tend to be followed by a class-action lawsuit against the manufacturer. The most notorious side effect of medication becomes the loss of control over one’s health. Similar to a traffic citation, any medication can add points against a patient’s license. Patients lose their ability to be in control of the wheel when they no longer know what medications they take or what these treat.
Can medication mask a more serious illness?
When I inquire about patients’ medical illnesses, I am surprised when they answer “no,” yet respond with “yes” when asked about being on medications. Does this mean a patient who takes medication for diabetes is not considered diabetic and does not have to follow a diabetic diet? Medications have the potential to make patients delusional, similar to the alcoholic who perceives alcohol as the solution and not the problem. Medication can treat diseases or symptoms of illness. Unmasking the illness or issues underlying any disease process requires more of serious conversation with the physician, distinguishing the fixation on medication from the physiology of disease and the psychology of illness. Ultimately, conversations regarding self-restraint with prescription medication foreshadow end-of-life discussions that might necessitate other types of artificial life support.
[i] http://content.healthaffairs.org/content/early/2014/11/13/hlthaff.2014.0947
Copyrighted and published by Project HOPE/Health Affairs as [include the full citation: author name, article title, Health Aff (Millwood), year or original publication, volume number, issue number, pages]
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