Episode 8: The Problem of Polypharmacy in Spinal Cord Injury. A Conversation with Dr. Sara Guilcher

Dr. Maxwell Boakye
September 15, 2021

A major issue plaguing spinal cord injury patients and the medical field as a whole is polypharmacy and the over-prescribing of pharmaceuticals. It’s a complicated problem without a “one-size-fits-all” solution. On this episode, I’m joined by Dr. Sara Guilcher to discuss the impact and risks of polypharmacy as well as some of the ways physicians can help tackle the problem and increase the quality of care for patients with a potential need for multiple medications.

You will want to hear this episode if you are interested in…

Defining polypharmacy [2:06]
The impact and risks of polypharmacy [5:48]
The role of pain in polypharmacy [11:00]
Examining the complexities of the polypharmacy problem [13:49]
Polypharmacy as a systemic patient safety issue [22:46]
Dr. Guilcher’s five steps to prevent polypharmacy [27:15]

Adopting a de-prescribing perspective

Polypharmacy is typically described as a patient who is taking five or more medications at once, yet Dr. Guilcher’s research shows it’s an incredibly pervasive problem. Why are so many doctors overprescribing their patients? Guilcher suggests that overuse of pharmaceutical solutions combined with a willingness to chase side-effects with additional medications is largely to blame. This is why she is such a big advocate for adopting a de-prescribing perspective in the medical community. We need to prioritize funding and research into non-medicated solutions to provide different and potentially better treatment options for patients.

Communication breakdown

You would expect the medical industry to have a detailed and universally shared record-keeping system that keeps providers and pharmacists up to date with a patient’s medication history. Sadly, that’s not the case in most situations. Medical professionals often don’t have access to a patient’s in-depth medical history for various reasons and expecting a patient to remember every medication and dosage is not realistic. This is why a universal record-keeping system is not only helpful in maintaining a patient’s quality of care, but is essential for solving the problem of polypharmacy.

Keeping the patient first

Many of Dr. Guilcher’s solutions for solving the problem of polypharmacy can be summed up by keeping the patient first when it comes to formulating treatment plans. Doctors often fail to consider the logistical impact of a patient trying to keep up with five or more medications. The consumption requirements of that many prescriptions alone could leave a patient trapped in their home. Putting the patient first when it comes to polypharmacy means thinking critically about every script written and how it will fit into their everyday life.