A case study of an elderly patient receiving polypharmacy and presenting with new neurological-related symptoms raises the concern that iatrogenic polypharmacy may obscure the presence of a disease and delay appropriate diagnoses and treatment. The case study was published in the AMA Journal of Ethics.
In the presented case, an 83-year-old woman who was taking 17 different medications presented to her physician with a newly developed intention tremor, slurring of words, ataxia, and depression. The patient reported fear that she was developing Parkinson’s disease, a heavy disease burden considering her other diagnosed health issues (ie, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, diabetes complicated by gastroparesis, and hypertension). The patient also reported feeling unsure as to whether she had a neurodegenerative disorder or whether her medications were causing her symptoms. Her symptoms worsened after recent hospitalizations, all of which corresponded with the prescription of several new medications.
This case suggests that iatrogenesis, or physician-generated illness or injury, caused the woman’s neurological symptoms. Further, iatrogenic polypharmacy, if a contributing factor to this case, is suggested to be a disease itself, and 1 in which treatment with further medications may be unsound. Considering as few as 2 concomitant drugs can introduce the risk for drug interactions and subsequent adverse effects, iatrogenic polypharmacy requires additional investigation to determine which steps clinicians should take in identifying, diagnosing, and managing medical-induced iatrogenesis.
In some instances, iatrogenesis resulting from polypharmacy can be managed by clinician-patient discussion regarding which medications are necessary and which medications can be safely discontinued. If possible, this may reduce and potentially eliminate the patient’s new symptoms, causing the physician to make a clearer decision as to whether a new disease has truly developed or whether the patient was merely experiencing drug interactions.
“More research needs to be done that is responsive to actual prescribing practices so that, in turn, clinicians can make more informed decisions when weighing potential benefits and risks of adding medications to a patient’s existing drug regimen,” author Christine Wieseler, PhD, from the Department of Philosophy at the University of Louisville in Kentucky, wrote. “While it seems inevitable that clinicians will need to prescribe multiple medications to some patients in order to manage their conditions, better health outcomes are likely when polyprescribing involves careful coordination among clinicians, avoids unnecessary medications, and is informed by an evidence base that takes into consideration the reality that many patients take multiple medications.”
Wieseler C. When should iatrogenic polypharmacy be considered a disease? AMA J Ethics. 2018;20(12):E1133-E1138.