Dr James Le Fanu: 17 May
The everyday practice of medicine may seem much the same as ever but recent years have witnessed a profound shift in favour of doctors staring at their computer screens, doing lots of tests; and an enormous, indecent enthusiasm for prescribing drugs. The number of prescriptions has increased threefold in just 15 years, so it is now not unusual for those in their 70s and beyond to be taking half a dozen different medications.
The driving force behind this ‘escalating polypharmacy’, as it is called, might seem commendable enough; the prevention of heart attacks and strokes by the early treatment of the predisposing ‘risk factors’. But the practicalities are rather different. As one patient put it: ‘I visited my surgery for a flu jab in a good state of mind and ended up a worried patient’, when the practice nurse seized the opportunity to measure his blood pressure and suggested ‘a few blood tests’.
Summoned back a week later, such patients learn they have hypertension or diabetes or are candidates for a coronary – warranting medical treatment indefinitely. This is all very unsettling, especially as they often go on to develop side effects to their medication – general malaise, unusual aches and pains, poor concentration and so on.
‘Would I be right in thinking the purpose of my joining the vast numbers of people taking unnecessary drugs is to boost the practice’s income?’ enquired a 76-year-old woman. And that, regrettably, is the nub of the matter.
The origins of this escalating polypharmacy date back to the renegotiation of GPs’ contracts in 2004, linking their remuneration to their achieving certain targets based on a ‘population-based’ approach to medical practice.
It works like this: there is no denying the value of treatment for the minority of individuals whose elevated levels of blood pressure, cholesterol or blood sugar increase their chances of suffering from circulatory disorders. Most heart attacks or strokes, however, occur in the much greater numbers in whom these measurements are only slightly elevated. This populationbased approach means that they too would benefit (though to a much lesser extent) from medication to lower levels to normal – which just happens to include virtually everyone over the age of 70.
Family doctors may query these targets and their potential for overmedicalisation – but are nonetheless compelled within their current contractual arrangements to adhere to them. This is a most invidious situation for which there is no ready solution, other than for the public to be aware of what is going on. It would be prudent, before consenting to take medication for life, to request that the doctor provides unequivocal evidence that it will be of value.
drjames@lady.co.uk
The driving force behind this ‘escalating polypharmacy’, as it is called, might seem commendable enough; the prevention of heart attacks and strokes by the early treatment of the predisposing ‘risk factors’. But the practicalities are rather different. As one patient put it: ‘I visited my surgery for a flu jab in a good state of mind and ended up a worried patient’, when the practice nurse seized the opportunity to measure his blood pressure and suggested ‘a few blood tests’.
Summoned back a week later, such patients learn they have hypertension or diabetes or are candidates for a coronary – warranting medical treatment indefinitely. This is all very unsettling, especially as they often go on to develop side effects to their medication – general malaise, unusual aches and pains, poor concentration and so on.
‘Would I be right in thinking the purpose of my joining the vast numbers of people taking unnecessary drugs is to boost the practice’s income?’ enquired a 76-year-old woman. And that, regrettably, is the nub of the matter.
The origins of this escalating polypharmacy date back to the renegotiation of GPs’ contracts in 2004, linking their remuneration to their achieving certain targets based on a ‘population-based’ approach to medical practice.
It works like this: there is no denying the value of treatment for the minority of individuals whose elevated levels of blood pressure, cholesterol or blood sugar increase their chances of suffering from circulatory disorders. Most heart attacks or strokes, however, occur in the much greater numbers in whom these measurements are only slightly elevated. This populationbased approach means that they too would benefit (though to a much lesser extent) from medication to lower levels to normal – which just happens to include virtually everyone over the age of 70.
Family doctors may query these targets and their potential for overmedicalisation – but are nonetheless compelled within their current contractual arrangements to adhere to them. This is a most invidious situation for which there is no ready solution, other than for the public to be aware of what is going on. It would be prudent, before consenting to take medication for life, to request that the doctor provides unequivocal evidence that it will be of value.
drjames@lady.co.uk