My Mum's unexpected passing last week brought some interesting findings and revelations. For all the fancy, shiny new tools and sophisticated strategies, the one thing that often gets forgotten is that at the end of the day there are not only doctors writing scripts but patients taking drugs for various ailments. How often do patients give up treatments because the grade 1 or 2 side effects are more inconvenient than the illness they are purporting to protect against? How many elderly patients forget or become confused about why they are taking such prescriptions, especially if they have a variety of different things for different diseases? No wonder the brown bag syndrome evolves.
My mother was one of those patients.
Last Christmas, she confided in me that she couldn't remember anymore which pills she should be taking, what they were for beyond her inhalers for COPD, which she took religiously every morning with a cuppa. The rest she was dubious about and rather scathing. Guess what, seeing a variety of different doctors across two surgeries
didn't help either because none of them took a look at the bigger
picture. It's just another patient to see in the 10 min appointment
slot with complaints that could be caused by almost anything.
All she knew is that she had severe muscle aches and pains, constipation and nausea. She wasn't sure which prescriptions were affecting her negatively, nor could she remember when the symptoms started. Her practical view was to stop taking them all except the inhalers and if the original problems came back she would toodle off to the GP and sort it out afresh.
Ummmm. No amount of gentle persuading on my part would convince her otherwise, even though she was a former nurse and more aware and articulate about medical matters than most. She felt perfectly fine without them all and was at her most cheerful in years free of all the drug side effects that had plagued her.
Unfortunately, that strategy ultimately proved to be her downfall.
While sorting things out, my brother and I decided to return the unused inhalers to the doctors practice for appropriate disposal. Except that it wasn't one or two of them. There was a whole hamper box full. And then another hamper full of brown bottles. A medicine cabinet was chock full of other stuff. We looked warily at them. Half of them I had to look up myself later. Pills for hypertension, raised blood pressure, hypercholesterolemia, diuretics, congestive heart failure etc etc.
On closer inspection, the furosemide seemed to be the most likely culprit for the side effects my Mum complained about; nausea, dry mouth, muscle weakness, constipation, blurred vision and headaches.
Sometimes we need to have a greater understanding of the realities of patients. If you go to the doctor feeling unwell and walk out with a prescription, the general expectation is that you want to feel better and have those symptoms resolved, not gain a bunch of inconvenient side effects that make your daily life utterly miserable.
What we need is a real strategic understanding of compliance, it's management, drug interactions and a broader picture of how patients with multiple common problems e.g. congestive heart failure, high blood pressure, hypercholesterolaemia etc could be better managed. Pharma is renowned for giving out those naff little pill boxes for the week, but these problems go much deeper than that, a broader, more strategic approach to disease management is really needed. Such a coordinated approach to health and disease will likely lead to better patient outcomes, reduced costs and happier people all around.
Otherwise, in the end, the brown bag syndrome means that patients could well end up throwing out the baby with the bath water and that does no one any good.