Less is More

My eighty-five year old patient shuffles slowly into my clinic, her caregiver in tow

Compared to her last visit, she is visibly more slow

I go in to see her, after her medications have been updated and reconciled

Right away I see a problem with the medications in her electronic medical record filed

She is on too many medications, both over-the-counter and prescribed

Among her medications there are many drug-drug interactions described

I see that her blood pressure is much lower than in the past

And drops down further when she stands up fast

Additionally she has three pills to help her sleep at night

She has glaring risk factors for falls in plain sight

*

She cannot remember why she takes some medications

“I just take the pills before me” is her simple explanation

She is seeing various specialists, myself being one

Each of us has just handed her some more prescriptions..

*

I realize that the best thing I can do for her now

Is to simplify her complex regimen and allow

For higher blood pressure and lower risk of falls

I am reminded that in medicine, one size does not fit all..

*

I de-prescribe medications, set supplements aside

Next visit I see an improvement in her spirits and her stride

She is more animated, blood pressure is normal too

“Less is more”, this phrase does ring true