DR. WARREN STRICKLAND, M.D., F.A.C.C.
I’m an interventional cardiologist, and actually I’ve been practicing medicine now for about 20 years. I trained at Tulane in New Orleans. I did my intro medicine, cardiology, and cardiology fellowship there. I moved to Huntsville about 18 years ago and ever since I’ve been in private practice here. You know, one of the things I’ve noticed over the last 5-6 years is that more of my patients that were sent to me for consultation were having symptoms and complaints that were related to adverse drug reactions, and I stopped to think, “Why was this happening? Why am I seeing more of this occurring now?” And then, I began to realize, since I graduated from medical school, really the practice of medicine has changed. The primary care doctor is no longer the quarterback. The average patient that I see will see four or five different practitioners. They see cardiologists, family practitioners, nephrologists, rheumatologists. They all are writing medicines – but no one was really paying attention any longer and that’s what really started – I guess baited – my interest into taking a deeper look into polypharmacy.
Can you describe how you first got interested in this approach to medication reconciliation?
You know, initially, I really felt – up until I got involved in personalized medicine – that I was a very good physician, but the more I started to investigate the value of medication reconciliation and stop and take a look – I was really passing some very simple drug interactions that were resulting in a significant discomfort, or causing a lot of symptoms in my patients that I didn’t recognize. Simple over-the-counter medications, such as Benadryl, can really result in significant side effects for your patients. These are little things, just simply from the lack of education, the lack of knowing, [or] the lack of realizing that it could have that type of impact. Most of us, particularly self-specialists, but we are all guilty to some extent, were only interested in the medications that we prescribe to the patients, but you really have to take a look at all of them – the whole big picture.
How did your practice change when you started using this capability in your practice?
As I got more involved [and] as I saw more patients with complaints, my whole approach to the patient and management to that patient changed. We are all talk – again in medical school – that when a patient presented to the office with a complaint, we wanted to start that patient on a medicine, and that’s the way 99% of physicians practice medicine. But now when I see a patient, as far as I’m concerned, one of those medications is guilty [and] is responsible for the patient’s tachycardia, dizziness, lightheadedness, passing out, [or] change in mentation, so instead of starting a medicine, I start stopping medicines. I cannot tell you how many patients that have presented for many months with disabilities and it was the result of a drug-drug interaction. You stop four or five of the medications [and] the patient improves. And most importantly, a lot of our patients are on a fixed incomes, so it has a huge impact on their overall financial well-being, so it’s really it’s a win-win in so many different ways.
Do you have a particular patient scenario that you can share with us where this made a difference for the patient?
You know, I can think of so many different. Let me give you a patient that I saw just last week. I had a patient that had Irritable Bowel Syndrome and Irritable Bowel Syndrome can be very difficult to treat. Usually, patients will have diarrhea rather than constipation, and a lot of it – not sure exactly what causes it – can be due to emotional stress, but this patient was referred to me because of unexplained tachycardia. The patient had several episodes of atrial fibrillation, atrial flutter, and it was really disabling for this patient. I took a look at her medicines, and she was really actually on three very potent anticholinergics. She was on Bentyl, she was on Robinul, [and] several other medicines to try to control her symptoms, but it was actually the medications that had been prescribed to control her symptoms that were causing her problems. It was discontinuing those very potent anticholinergics – the Bentyl and the Robinul – and her tachycardia, which she had spent thousands of dollars in trying to get evaluated, completely resolved.
Can you comment on what type of patients might best benefit from this type of approach?
If you look at the average patient over the age of 60, [they are] on five (5) or more medications. Everyone really should – if you don’t have a physician who’s involved in intense medication management – you should ask him to review your drugs when you come in to make sure that you’re on appropriate medication, or [to] send you somewhere where you can have medication reconciliation preformed, because it’s really, really important. It’s an important part of your healthcare to make sure that you’re on appropriate medications and that someone is paying attention.