The neglected art of stopping medications

Whenever a medication is re-prescribed, some thought should be given to the important art of ‘deprescribing’.

Doctors are taught far more about starting medications than stopping them, and most pharmaceutical research ignores the ‘cessation’ question altogether. Each 6-monthly round of prescriptions inevitably seems to include more than the last.

Some categories of drugs are particularly prone to outstaying their welcome, long after the initial problem has resolved – just think of antidepressants, opioids and vitamin B12 injections.

Our team of five GPs on the Choosing Wisely Australia initiative decided to highlight the example of stomach antacids as a classic example of over-prescription.

These ‘proton pump inhibitors’ (PPIs) are wonderfully effective at reducing acid reflux symptoms, but unfortunately patients tend to stay on them long after the symptoms have resolved. Not only for months, but years – even decades!

Why? Well, heavy marketing helps, and also the aforementioned relative lack of education and discussion among doctors about pressing the ‘delete’ button in their prescribing software.

DEPRESCRIBING: the one topic you can guarantee never makes the agenda during a pharmaceutical-sponsored education evening!

Last week I put my creative juices to work, and produced this 3-minute video about deprescribing PPIs. It took far more hours’ work than I like to admit (I had to learn to draw, for a start!), so please do share it on your own social media if you can.

Even if you’re not a prescriber yourself, a share might go a little way towards highlighting the issue. By the time we all get old and juggle ten medications, we’d better hope plenty of research and educational effort has been put into deprescribing!

 

About Dr Justin Coleman

Justin is a GP working in Aboriginal health in Brisbane, Australia. He is also a medical writer, editor and blogger. Further details at https://drjustincoleman.com/
This entry was posted in Naked Doctor and tagged , , , , , , , . Bookmark the permalink.

3 Responses to The neglected art of stopping medications

  1. Excellent work – more, please!

  2. anneharrison says:

    Well done with the video (and drawing).
    My pet grievance is warfarin/NOAC/plavix in the frail elderly – just what are we trying to prevent? Working as I do in a hospital, even when patients are deemed for comfort care only, few are willing to put a line through such a range of medications (even when the patient can’t swallow!)
    I often wonder if we have lost the art of actually making a decision….

  3. Pingback: Deprescribing: a fancy word for ceasing? | drjustincoleman

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s