Decluttering with Marie Kondo ... and Your Pharmacist!The Feng Shui of MedicationsPeter Rice Dec 1, 2020
Marie Kondo is a Japanese neatness guru whose principles have inspired many households. She is the author the best-selling book, The Lifesaving Magic of Tidying Up. Her main concept is to throw out anything in your house that doesn’t bring you joy.
Ever find yourself cluttered up? Might be a magazine you’re subscribing to for years that accumulates each month, takes up your time, but does not necessarily bring its earlier joy into your life. I found that home improvement magazines just make my wife less satisfied with our home, but they have projects we might use someday so we can’t get rid of them. Then, just like that, you find yourself needing someone like Marie Kondo in your life to help you bring everything back into balance.
The same type of thing can happen with medications. Clutter!
Many patients take some of their medications for relief of symptoms. These medications are different from the ones you take to control disease states like high blood pressure, diabetes or high cholesterol. Medications for symptomatic relief are intended to help patients feel better in some way. And the best judge of how you feel is you.
As a pharmacist and pharmacologist specializing in drug actions, I’ve reviewed patient medications for many years. Medication regimens can develop to become quite complex. I recall a woman from Morristown, Tennessee from many years ago who was taking 18 different medications, never going more than two hours between taking something. Each medication both solving a problem and potentially contributing to at least one other problem. Medication clutter!
You start a medication that appears to help you, but over time it just does not seem to bring the same relief to your symptoms. If you’re like many patients, you keep taking the med. After all, things might be even worse if you were to stop it.
A medicine might be a good choice at first, but later on just not work so well. Sometimes the body initially responds with a nice effect to the medication, but eventually adapts so that patients feel as though they’re taking meds just to feel normal.
Aging can affect underlying disease states as well as how the body metabolizes medicines. Many symptoms seem to worsen over time, making them a little harder to relieve with medications. A higher dose of medicine may help the original symptom, but also cause other side effects. Even without an increase in dosage, as patients grow older medicines tend to remain longer in the body and can cause additional side effects.
We choose what we believe are the best medications for an individual patient by comparing the benefit and the risks. A drug’s potential benefit to a patient and potential risk both change as patients age and as their life priorities change.
Drugs can have all sorts of side effects. Patients will put up with some of them, but not others. As pharmacists, we are used to helping docs and patients choose the medicines that will help without producing an unacceptable side effect. This means knowing our patients as well as their medications. When we’re really lucky, a medication helps patients feel better in more than one way, like easing pain and helping with sleep.
“When we really delve into the reasons for why we can’t let something go, there are only two: an attachment to the past or a fear of the future.”
- Marie Kondo
Pharmacotherapy is the art – the feng shui - of optimizing medications. Talk to your pharmacist about your medicines. Pharmacists can work with providers to identify medications that are ineffective or problematic, and if needed can usually propose alternatives that improve overall quality of life. This approach often involves working closely with patients and prescribers to identify and stop some medications if they are not helping. We call this de-prescribing.
As Marie Kondo suggests, patients often fear letting go of a medicine that has worked in the past because the future may be even worse. Your pharmacist can provide a thorough medication review, and like Marie Kondo, can work with you and your prescriber to de-clutter some medications and change your life for the better.