A/Prof Sarah Hilmer: Starting and changing medicines
Listen to patients and health professionals speak about their experience with taking multiple medicines.
A/Prof Sarah Hilmer
Main occupation: Clinical pharmacologist
Years in clinical practice at interview: 16
Qualifications: BScMed (Hons), MBBS (Hons), FRACP, PhD
Associate Professor Sarah Hilmer, clinical pharmacologist and geriatrician, explains that advances in medical science and people’s needs change over time, which means their medicines may also need to change.
You really have to explain that, firstly, medical science has changed over the past 50 years and what we thought was good for one condition 50 years ago, we may now think is not so good. Also, they have changed and, while their aims 50 years ago may have been more around prevention, now that they're frail and in a nursing home, their treatment aims are more around symptomatic relief. The benefits of prevention may be relatively small and not worthy of the adverse drug reactions and the side effects they're getting from the medicines that might prevent something down the track … Yeah look, it depends very much on the patient and the condition and their views on their healthcare and where they are at that time.
It's really important to get consensus between the healthcare professionals in hospital, the healthcare professionals in the community, and the patient and their family, if you are going to make any changes to medicines. I think one thing the patient has to understand is that a medicine that was indicated at the time it was prescribed and may well have done them some good for some time may, after some passage of time and changing medical conditions and changing functional state, actually have tipped the balance the other way and now be doing them more harm than good. And most people can understand that.
And then we talk about the relative risks and benefits of being on the medicine, compared to not being on the medicine, and then we talk about how to safely stop it. And you can't stop some things cold turkey; you'll run into trouble with withdrawal reactions. You have to withdraw them gradually. But we go through that and we explain what to look for and we monitor the patient carefully and make sure that people understand that stopping a medicine is actually a therapeutic intervention. We are doing that to help. It's not that we're giving up on them. It's not that we don't want to treat them. It's that actually stopping the medicine will make them feel better than being on it.
The Living with multiple medicines project was developed in
collaboration with Healthtalk Australia.