2004-10-15 / Columnists

Eye On Physical Therapy

By Dr. Tim Rohrs

There is an old saying that goes “too many cooks spoil the broth”.

I agree with that quote not only for cooking but for health care as well. Just as in a professional kitchen there is the head chef, there must be a “head chef” when it comes to the delivery of health care services.

When performing an evaluation on a new patient to my office, I ask about the prescription medications, vitamins and supplements a patient is taking. Medications, prescription and over the counter, can effect how a person reacts to exercise, heat and fatigue while in therapy.

In the elderly this list of meds could be 15 or more medications taken multiple times throughout the day. A red flag warning usually goes off in my head when I hear a list that long. Far too often the patient has been prescribed different medications by numerous doctors. Their cardiologist has them on some. Their internist has them on others. The orthopedist has added a few more to the list. On top of the prescribed medications, there are often supplements that the patients’ friend or the local health food store has recommended. You might say to yourself, “Well, all the medications have been ordered by licensed physicians, so what is the problem?” The problem is that far too frequently the primary care physician has not been told about all the medications prescribed by the other doctors.

Recently, I had a patient who started experiencing cold sweats, light headedness and fatigue; and this was before her treatment even started. Her blood pressure was 198/102. I immediately sent her to her primary care physician. It turns out she was recently put on a new medication by one of her other doctors, and combined with the medications she was already taking caused these side effects. The primary care physician did not know about some of the medications because she had been to 5 or 6 other doctors who had given her different prescriptions.

Just as the head chef must know what everyone is throwing in the pot, the primary care physician must know all the medications prescribed by other health care providers. This includes knowing about over the counter drugs, supplements and alternative medications.

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