When ''Less Is More'' for Your Patients

Eric ReinesWhat should I do for my nursing home patient? She has become more fretful when meds are administered, and her appetite is off. She complains about all the pills.

Indeed, she takes pills for osteoporosis, hypertension, diabetes, hypercholesterolemia, G-E reflux, COPD, pain of osteoarthritis, constipation, depression, anxiety, and dementia.

Her family exhorts her to take the pills that have been prescribed by her multiple specialists over the years. But does she really need all these pills? Will they enhance her quality of life, her ability to function independently, her longevity? Is there reliable evidence to help us decide, whether in textbooks, clinical studies, or guidelines?

We geriatricians, as well as physicians of all specialties, face similar dilemmas daily. Many of us are coming to the realization from experience that “less is more,” and there is an emerging body of evidence to support this view. For instance, advanced lung cancer patients live longer with palliative care than with aggressive cancer treatment. Elderly, multi-morbidity diabetics fare better when HA1C goals are relaxed. The Joint National Committee has just relaxed blood pressure guidelines based on new evidence.

Acting as stewards of health care resources for all of society turns out to benefit our own individual patients as well. In the spirit of “Less Is More,” the MMS has adopted policies calling on regulators and insurers to apply evidence appropriately when promulgating guidelines and pay-for-performance programs, and represents physicians at the Statewide Quality Advisory Committee.

The MMS Committee on Geriatric Medicine invites you to join us in learning how to get off the treadmill of testing and treating and start learning what matters most to our patients.

  • Read the series, “Less Is More,” in JAMA Internal Medicine
  • Familiarize yourself with your own specialty’s “Choosing Wisely” campaign at www.choosingwisely.org
  • Advocate for wise policy and quality measurement at the SQAC and other agencies

—Eric Reines, M.D.
Committee on Geriatric Medicine Chair

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