Ethics of Deprescribing in PALTC

“Glenda” has multiple comorbidities, lives in a long-term care facility, and sees six specialists besides me, her primary care physician in the facility. She takes 31 medications for a multitude of symptoms, many of which are likely caused by adverse drug effects. On numerous occasions, I have discussed the risks and benefits of each of her medications and the probability of drug-drug interactions as well as her declining renal and hepatic function which impairs clearing of the medications. Occasionally, Glenda will agree to reduce a medicine, but then she’ll call her cardiologist, gastroenterologist, or endocrinologist to increase her doses again or to reinstate a stopped medication, increasing her medication burden and the risk of adverse events.