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Why the Pharmacology Principle of Administering A Minimum Dose of Medication To Get The Desired Effect is WRONG

By Health2 Comments

In recent years the pharmacological principle of prescribing and administering the minimum dose of medication to get the desired effect has become common place in medicine. Despite not being a Doctor or Nurse Prescriber I have come to believe that this approach is fundamentally wrong. In this post I explain why.

medication-pills

The medication that I take each morning.

Let me explain why the theory and practice has become so popular. It has lots of benefits. It helps prevent patients being overdosed on medications, minimises the likelihood and severity of side effects; can prevent or reduce the risk of patients becoming tolerant to medications and microbes from developing drug resistance (such as antibiotic resistance).

These benefits all sound good, so lets looks at the risks and why I believe the risks outweigh the benefits – put simply why I think this approach is wrong.

The biggest risk is that patients get under-dosed, leaving them in pain or suffering due to Doctors and Nurses being too cautious. Another risk is that Doctors and Nurses are always looking to reduce doses at medication reviews. This could be physically, mentally and emotionally harmful to the patient. Some may argue that pathways are in place to prevent under-dosing and harm. But pathways don’t always account for the complexity of the individual patients.

Here are some examples of when this theory of giving the minimum amount of medication to get the desired effect doesn’t work:

  • A patient brakes their arm and has the bone sticking out. They are understandably in a lot of acute pain. However a pathway, Doctor or Nurse may choose to start them on paracetamol and work up to stronger painkillers. In this case the patient is likely to need Morphine, which is at the top of the pain management pathway. This may result in several hours (or more) of severe pain.
  • A patient with chronic back pain attends a Pain Service for medication review. After the initial assessment, the Doctor or Nurse decides to lower doses of medications despite the patient saying that they’re struggling with the pain. They refer to Physiotherapy – a good decision, but still reduce the doses of medications. This leads to anxiety, possible depression and more physical pain.
  • An elderly patient has a urine infection and type 2 diabetes. After several GP visits due to constantly needing the toilet, she gets antibiotics. However they are of the lowest dose, indicated by a urine infection pathway. The patient has to return to the GP to get a higher dose. During this time her blood sugars are high, leading to even more urination, the risk of dehydration and other associated complications of having a high blood sugar over a prolonged period of time.
  • A patient with mental illness such as bipolar isn’t put on high enough doses of antipsychotics and/or antidepressants. They are given the dose that is as little as possible and it is not increased despite the patient asking for this. This means that the patient has continual relapses and repeated admissions to mental health wards.

I try to avoid writing about things that could cause controversy. But my recent 15 day stay in a mental health ward and experience with community mental health services has left me having being given less than the standard doses advised in the BNF on two mood stabilisers. I believe that standard doses of medications exist for a reason. These are levels of medication that experienced clinicians through research have found to be effective.

I now face an uphill struggle and a battle to get medications I need increasing increased due to this theory. This is why I believe it is fundamentally wrong. Because of the risks of under-dosing and causing harm. I’m sure I’m not the only one affected by this principle, it is no doubt many others across the country and Western world.

Write soon,

Antony

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Wonderful Websites – General Health

By Health, The WebNo Comments
wonderful-websites-image This is the first blog post in a series titled Wonderful Websites. This post focuses on the most wonderful websites for general health.

1. NHS Choices is crammed with health information. Information on health conditions, treatments, medications, public health issues, carers right, services, practically everything you could ever want to know about health and healthcare in the UK. Delivered by the NHS you can be assured of correct information that is up to date and based on research and evidence.

It has some great online tools such as: BMI Calculator, Mood self-assessment, Sleep self-assessment and many more.

2. Patient.info has a A-Z list of articles written by doctors, information videos, a symptom checker and an active online community. On more than one occasion while at work in the NHS, I’ve seen doctors checking this valuable website.

3. NetDoctor is similar to Patient.Info, but with more of a focus on healthy living and healthy eating.

4. eMC (Medicines.org.uk) is a useful website for looking up information about medicines.

I use British National Formulary (BNF) but the medical terminology can be difficult for some from a non-medical/non-nursing background to understand; this is why eMC made it on this list instead of the BNF.

5. Office of National Statistics – Health and Social Care is the best place to find statistical information about health. It is regularly updated based on data from the NHS, Local Authories and other Government Departments.

6. National Institute of Clinical Excellence (NICE) provides pathways, guidelines and advice across the UK for best possible evidence-based healthcare. The guidance they provide is developed by groups of clinical experts who provide experience of what works in practice and by examining and analysing research.

If you want to know what care you or a relative or friend should be receiving and check that it’s high quality visit NICE’s website.

7. Health For Teens I found while doing research for this post. It’s specifically aimed at teenagers and looks appealing. They even create content in consultation with young people. I think the name of the website maybe off-putting to young people though – but this is just my personal opinion.

Are there any health websites that you think are useful that aren’t on the list? If so leave a comment below and let me know.

The next post in the Wonderful Websites series will look at websites for mental health and mental illness.

Write soon,

Antony

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International Nurses Day – 5 Quotes About Nurses & Nursing

By Health, ThinkingNo Comments

Today is International Nurses Day. Nurses play a critical role in healthcare across the world. Here’s 5 inspirational quotes about what it means to be a Nurse and about Nursing:

5-quotes-about-nurses-and-nursing

Blog soon,

Antony

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The Cycle of Life

By Life, ThinkingNo Comments

Life is a cycle. It has stages or distinct periods, associated with age and these ages are also associated with key events. Everyone who lives a full life cycle will goes through each of these stages. They are:

cycle-of-life-diagram-by-Antony-Simpson

The Cycle of Life Diagram by myself.

Prebirth
There is some debate between Scientists, Doctors, Religious Leaders and Philosophers about when human life actually begins. Some say it begins at conception or fertilisation (generally most Religious Leaders), whereas Scientists and Doctors in the UK state that human life begins once a fertilised egg has implanted its self into the uterus wall, based on medical research and legal judgements.

Whichever you believe to be correct, this stage of life goes from 0-40 weeks. In this time you grow from a single cell into an embryo (from day four of fertilisation to week eight of pregnancy) and then into a foetus (from week eight of pregnancy till birth). Your mother will go through the three trimesters of pregnancy. You will be called a baby from birth.

Birth
You come into this world as a baby that is fully dependent on your mother, father and/or other carers to meet your needs for: milk, hygiene, warmth, sleep, safety, stimulation and love (emotional attachment and bonding). This is a period of rapid physical growth.

By 3-6 months old you will need to be weaned on to solid foods to satisfy your hunger and to give you enough nutrients to continue this rapid period of growth. Between 6-9 months old you will begin exploring your environment by crawling.

By 1 year old you begin to walk and enter into the infancy stage of your life cycle.

Infancy
In this stage you learn through exploration and play. This stage is usually between the ages of 1 to 5.You develop in all sorts of ways including:

  • Physically – you continue to grow, develop gross and fine motor skills.
  • Cognitively – you develop your ability to solve basic problems and begin to develop your imagination.
  • Language – You learn to communicate verbally through speech. You will go from knowing a handful of words to hundreds.
  • Socially – You learn to parallel play, share and social rules.
  • Emotionally – You learn to identify what you feel and eventually to emotionally regulate yourself.
  • Moral – You begin to notice what is perceive as right and wrong.

In infancy, a significant phase for most parents or carers is the terrible twos. To call it the terrible twos is a bit deceptive though, as it starts from around 18 months and can carry on until the infant is 2 and a half years old.

You say ‘No’ often and temper tantrum if you don’t get your way. In the terrible twos you are learning what the boundaries are, what you can get away with and how to regulate your feelings of frustration and anger when you don’t get what you want.

Childhood
Personality begins to develop in childhood, including likes and dislikes. Childhood starts at around 5 years old and ends around 12 years old (its ending being marked by the beginning of puberty – see Adolescence below).

As well as your personality developing, you become much less dependent on your parents or carers for your basic needs. You start structured learning at school, which leads to a more structured way of thinking. But conversely you are able to think abstractly.

You increase the number social relationships you have by making friends. You continue to grow – both physically and intellectually and continue to develop new skills. You may master some of these new skills. You have thing that pique your curiosity and things that don’t. You have passions and interests.

Adolescence
The stage of adolescence or the teenage years starts around 12-13 years old and lasts until around 18-20 years old. The end of childhood and beginning of adolescence is marked by the start of puberty.

In adolescence your body and brain are going through massive changes. These changes mean that you need more sleep and may well be found sleeping in till midday or later.

In the body, high levels of hormones rage creating physical changes, increasing emotional intensity and a fierce need for independence. The emotional intensity explains why you are more likely to be rebellious in your thinking and actions as an adolescent.

If you’re a male physical changes include: body hair grows (public, underarm, facial & legs), voice breaks – becoming deeper, Adam’s apple becomes prominent, acne, penis growth, lowering of testis lower, growing taller and broader.

If you’re female physical changes include: growth of breasts, menstrual cycle, body hair grows (public, underarm & legs), acne, weight gain, change of body shape and growing taller.

In the brain, hormones make you more likely to act on impulse and take risks. This explains why you are more likely to try alcohol and/or drugs in adolescence.

Both the body and brain make you aware of those you feel sexually attracted to. You notice them. You want to get to know them and ultimately you want to have sex with them. You may start to have sexual and/or romantic relationships.

Your thinking is egocentric – you are only or mostly concerned about you. This egocentric thinking explains a lot of your thinking and behaviour including why you are so concerned about how you look.

Puberty takes around 4 years from the early signs to completion. As well as all the puberty changes, you have the pressures of high school including peer groups and exams.

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Early Adulthood
18-40 years old is the Early Adulthood stage of the cycle of life. Adults are physically fully grown and must use the life skills that they acquired in earlier stages to fend for themselves. In these few short years a lot happens in life.

You may move out of home, you may go to college and/or university, you may learn to drive a car, you go out into the world of work and start your career, you may make a commitment to a partner through marriage, you may end a relationship through divorce, you may buy your own home, you may have children of your own, you may travel, you may become more involved in community activities.

You feel enthusiastic about making your mark on the world. You continue to develop your passions and interests. Days, months and years pass quickly by at this stage of your life. You have little time to contemplate your life and the past choices you have made that have lead you to where you are.

Middle Age
Contemplation is the keyword in middle age, which starts around 45 years old till around 65 years old. Physical signs of ageing are present and women will have gone through menopause by the end of this stage. People talk about having a midlife crisis in this stage.

You think about your life and if you are happy with it or not. You may feel that your life is stale and stagnant. This contemplation can cause you to make major changes in your life. However you may be perfectly content with your life and choose to continue on without making any major changes.

In this stage of your life you may need to care for your now elderly parents. You will have attended christenings, birthdays, weddings and funerals. You will have met and know people at all stages of the cycle of life.

Late Adulthood
Retirement from work will have occurred by the time a person reaches late adulthood. Late adulthood is a stage for people aged 65-75 years old. By this point they have got a wealth of wisdom as a result of life experiences.

You physically and mentally begin to slow down. You have great wisdom from a lifetime of experience and regularly replay memories from your past.

End of Life
At the end of life the reflection continues. Most people will be 76+ years old. If people are happy with their life, they will feel satisfaction. However some people may have regrets.

People regret things like: not spending enough time with family and friends, not being the best parent/grandparent that they could have been, not having taken enough risks and playing it safe.

You will think about your life. You will ask yourself if you spent enough time with loved ones, if you did good enough, if you’re happy with your life up to now.

Death
According to The Office of National Statistics the average life expectancy for a man is 79 years old and for a woman 83 years old, so death comes between 79-83 years old for most.

Your family and friends will grief for the loss of you in their lives. Hopefully they will celebrate your life as well.

Rebirth
Rebirth hasn’t been scientifically proven at this point. But several religions and spiritual paths believe in reincarnation or rebirth. This is where you would be reborn either as another human or as an animal after death.

Even more fascinating is that some religions and spiritual paths even believe that it is your choice to be reincarnated or remain on an astral/spiritual/energy-based plane of existence.

The Future
A healthier lifestyle including: a good diet, regular exercise, not smoking, not drinking alcohol, not misusing substances, working/living in better environments with conditions that promote good health; along with ever-improving healthcare and technology will extend the life cycles of current and future people.

This extended life cycle will mean that some of the ages people enter the stated stages in this article will be incorrect in the future.

Blog soon,

Antony

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I aim for posts on this blog to be informative, educational and entertaining. If you have found this post useful or enjoyable, please consider making a contribution by Paypal:


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