When Doing Everything Right Creates New Risks
In healthcare, we often focus on proactive care. We screen early, treat risk factors, and follow guidelines. We add therapies shown to reduce long-term complications. On paper, it looks like we’re doing everything right; however, this can lead to polypharmacy.
But sometimes, doing everything right creates new risks. Polypharmacy.
Polypharmacy, commonly defined as the use of five or more medications, is becoming increasingly common, especially among adults over 65 and those living with multiple chronic conditions. In many cases, each medication is appropriate on its own. For example, a statin for cardiovascular risk. An ACE inhibitor for blood pressure. Metformin for diabetes. A PPI for reflux. In addition, an antidepressant for mood. All reasonable. All evidence-based.
The problem isn’t one medication. It’s the accumulation.
With each additional prescription, the risk of drug-drug interactions, adverse effects, prescribing cascades, and medication non-adherence rises. Dizziness leads to a fall. Fatigue leads to reduced activity. Cognitive changes get attributed to aging rather than medications. A new symptom appears and instead of reassessing the regimen, another prescription is added.
What began as careful guideline-based care slowly becomes clinical complexity.
Polypharmacy isn’t just about side effects. It’s about burden – financial, cognitive, and emotional. Managing multiple dosing schedules, refill dates, and pharmacy trips can overwhelm even the most engaged patient. For caregivers, it adds another layer of coordination and stress.
Importantly, deprescribing is not about withholding care. It’s about aligning treatment with current goals, life expectancy, risk tolerance, and quality of life. What made sense at age 60 may not make sense at 80. What was appropriate during an acute illness may no longer be necessary two years later.
Medication lists should not be static documents. They should be reviewed regularly, simplified when possible, and centered on the patient’s priorities.
As clinicians and pharmacists, we’re trained to add therapies to reduce risk. But we should be equally skilled at stepping back and asking:
Is every medication still necessary?
Are we treating the patient, or the protocol?
In an era of increasingly complex care, sometimes the best intervention is thoughtful deprescribing.