Less is More When it Comes to Prescribing Medication

"Less is more, a cautious approach that can save the day"

On an outpatient visit with a hypothyroid patient, a young woman told me about a recent hospitalization that illustrated a lesson tucked inside a silver lining. The patient told me the story of a recent sinus infection treated with an antibiotic, like many times previously, and the onset of an acute illness called DRESS syndrome requiring intensive care unit admission. This syndrome which is an acronym for drug eruption with systemic symptoms is a rare, potentially life threatening condition that affects liver, kidney and is usually associated with a drug reaction to a multitude of possible agents. Because of her young age and lack of other medical problems, she had recovered nicely from this acute illness and was comfortably sitting in my exam room.

The lesson for me is not that this antibiotic contributed to this particular event, but that medications that we use to treat routine illness are powerful and potentially dangerous. As physicians, most of us recognize this power and ascribe to our ethical responsibility to "do no harm." However, I see too many older patients, on polypharmacy, particularly in relationship to pain medications. Other patients, more commonly, younger and middle aged patients are on hormone medications, looking for the "fountain of youth" in a bottle of estrogen, testosterone or growth hormone. Often, the underlying reason for these medications is not well defined, but the physician and the patient have determined there is a "need" and the treatment is prescribed.

 Luckily, most medications will not have the profound, potentially life threatening effects that occurred in my patient. This recent visit reinforced to me the importance of being cautious and to always consider all of the reasons that a medication is prescribed. Patients demands quick fixes for medical problems but often, we might be better off with "a less is more" approach." I know my patient will always be looking for that kind of solution to her medical problems in the future.