Polypharmacy: The Wrong Word for a Serious Problem

As a rounding internal medicine pharmacist, I routinely care for patients who are admitted to the hospital with either a primary or secondary complaint most easily described as a side effect or toxicity from 1 or more of their home medications.

As our medical team makes rounds every morning, the physicians discuss the diagnoses and oftentimes look to me as they say the “P” word: polypharmacy.

I know I shouldn’t take it so personally, but to be honest, it always makes me feel a little dirty when they say it. I feel as though they are blaming my profession for the problem.

I remember learning in pharmacy school that polypharmacy had a somewhat fuzzy definition, but the gist of it was something like “the inappropriate use of medications” or “using 1 medication to treat the side effects of a different medication.”

Over the years, this seems to be the definition shared by my physician colleagues. Yet, when I look to Google to reinforce it, I’m left with a broad range of definitions like:

• The use of 4 or more medications by a patient, generally adults older than 65 years.¹
• The practice of administering or using multiple medications, especially concurrently (as in the treatment of a single disease or of several coexisting conditions).²
• The prescription or dispensation of unnecessarily numerous or complex medicines.³
• The practice of prescribing multiple medications for an individual patient, especially excessively, for a single disease.³

Some of these definitions don’t even suggest that polypharmacy is a problem. Others hint at it but fail to encapsulate the entire problem. Some definitions totally baffle me in that they are void of any hint of a negative connotation. Then, there is the root of the word itself, which simply suggests “many or multiple pharmacies.”⁴

All health care providers who are worth their salt know that the inappropriate use of medications is a serious, costly, and even deadly problem. I believe that the ambiguousness of the term polypharmacy not only fails to capture and define the problem, but also contributes to it in at least 2 ways.

First, prescribers who are aware of the problem fail to see that they have personally contributed to it with their very own prescribing practices. Without clear guidelines to define the term and the problem, it is easy for providers to assume that they have not violated best practices and take on an “it’s them, not me” mentality.

Second, without a clear definition, no one is held accountable for the problem because no one actually knows what the problem is. Prescribers may erroneously assume that pharmacists will catch all of their prescribing errors, while pharmacists may wrongfully assume that the prescribers know what they’re doing. Meanwhile, patients make the reasonable assumption that there is some level of communication between pharmacists and physicians.

This doesn’t even take into account the thousands of patients who choose to frequent more than 1 pharmacy to fill their medications. With all of these assumptions, ultimately no one is being held accountable, and therefore, no one feels empowered to fix the polypharmacy problem.

I don’t pretend to know the solution, but I would certainly advocate for new terminology that better defines the problem and more appropriately places ownership of it on prescribers. In the meantime, I will continue to educate my team on the importance of reconciling medication lists and being thoughtful about what medications they’re prescribing and for how long.

When they turn to me while announcing “polypharmacy,” I will smile as I internally scream, “Don’t look at me. I’m not the one who ordered this mix!”

References

• Wikipedia. Polypharmacy. https://en.wikipedia.org/w/index.php?title=Polypharmacy&oldid=695781036. Published December 18, 2015. Accessed February 28, 2016.
• Merriam-Webster. Polypharmacy. www.merriam-webster.com/dictionary/polypharmacy. Accessed March 8, 2016.
• The Free Dictionary. Polypharmacy. http://medical-dictionary.thefreedictionary.com/polypharmacy. Accessed February 11, 2016.
• Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: misleading, but manageable. Clinical Interventions in Aging. 2008;3(2):383-389.