Monday, 8 October 2007

The garden sign

Joe is in his nineties and lives alone in his house; some distant relatives “look on”. He spends most of his time sitting in his armchair listening the radio. The Saturday before last he felt unwell, and the out-of-hours service visited him and found his blood pressure was very low. They stopped all his medication (principally a diuretic and an ACE inhibitor) and asked me to review him on Monday. So I visited him and discussed things with his relatives who were also there. Stopping all medication is the sort of bold stroke that is much loved by professors of geriatrics. Indeed, I sometimes suspect that the main reason for prescribing drugs to the elderly is so that the eminent professor can stop them when they are next admitted to hospital. But it is easy for professors to do that because the patient is going to be under supervision on a hospital ward for a few days. It needs a little more courage, or foolhardiness, to stop all medication when the patient is alone at home.

However, Joe looked pretty well after two days off his tablets so I suggested he should carry on, and arranged to visit him again one week later. Today he was showing signs of mild fluid retention so I restarted the diuretic at a lower dose, but overall his condition had improved. “He's been down the garden” reported his niece. “He hasn't done that for years”.

Perhaps those professors knew a thing or two, after all.


The Shrink said...

I'm no professor, far far from it, but as a jobbing clinician I must confess that I find myself stopping medication at least as often as I start it.

But then as you say, either I've the luxury of reviewing them on an in-patient unit or following them up regularly and frequently in the community (with 3 people at present having daily visits by me or my team). Knowing you've robust follow up and decent surveillance does give more confidance.

But point taken, outside Primary Care we oft times can be a touch cavalier and trust you'll pick up the pieces!

eryn said...

Thats true, my geri consultants love crossing out medications from the charts ;-)
take care Dr Brown

Elaine said...

And it was just the same in my day )about 30 years ago)

There is nothing new under the sun.

Anonymous said...

Once upon a time old people were allowed to grow old naturally and with dignity. It's a relief to hear that common sense prevailed in Joe's case and that he has been spared unnecessary intervention. While Joe, it appears, has little need for high tech medicine, it's good to see that the support network available to him (including his very caring GP) is working well and allowing him to remain in his own home. There is no better medicine!

Dr Andrew Brown said...

Thanks all.
There is indeed no new thing under the sun, and we spend much of our time rediscovering things that were old hat to our ancestors. The NHS as an organisation has a particularly appalling memory.