16 Medications From Multiple Doctors, and No "Unicorn Pharmacist" Checking the List
Jonathan Bledsoe, a Marine veteran from Reading, Pennsylvania, took one prescription for his mood and one for his cholesterol, among a handful of others, for nearly 3 years.
Then one morning his urine came out "the color of fresh brewed coffee."
The 2 drugs were interacting and starting to damage his liver. He'd had multiple doctors. None of them caught it until he brought the symptom back himself. After he changed medications, his liver and kidney function returned to normal.
"You wouldn't think you would have to be your own advocate," he told KFF Health News.
You do. That's the problem.
The share of Americans over 65 taking 5 or more medications nearly doubled from 2000 to 2020. Today more than a third of older adults take 5 or more a day. Amanda Mixon, a hospitalist at Vanderbilt University, says she sees older patients averaging 16 medications, often from multiple prescribers and pharmacies.
Each prescriber may not know what the others ordered, especially when they practice in different health systems with separate electronic charts. Pharmacist DeLon Canterbury put it plainly:
"Do not assume that someone is checking all of these things in the background. There isn't this magical unicorn pharmacist just making sure everything is safe. Yes, even at the local pharmacy."
Then there's the prescribing cascade. A heart failure patient gets a water pill. The water pill causes incontinence. The incontinence gets its own pill. One prescription becomes 3, and nobody stepped back to look at the whole shelf.
Nobody is being careless on purpose. "It's not the intent of our providers to overtreat," Canterbury said. "It's just what we've been trained to do." Fee-for-service medicine pays for adding. It took until this year for Medicare to issue guidance clarifying how doctors and pharmacists can be paid for reviewing medications and helping patients taper off. Before that, physicians weren't sure they could get paid for deprescribing at all, even though untangling a med list takes real time.
Time is the whole thing.
By 78, a patient can easily have a cardiologist, an endocrinologist, a rheumatologist, and a primary care visit that lasts 12 minutes. Nobody owns the list.
A direct care doctor isn't racing a billing clock or waiting for a new Medicare code to justify a 45-minute conversation. There's room to sit down with every bottle on the table, ask what each one is doing, and ask the question a 12-minute slot squeezes out: Do we still need this?
If you're the adult child of an aging parent, do one thing before the next appointment. Write down every prescription, over-the-counter pill, vitamin, and supplement in one place. "Everyone needs a medication list in their pocket," says pharmacist Jen Hammons. A folded piece of paper in the wallet works fine. Then sit down with a doctor who has the time to read it from top to bottom.
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