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.