10 minute consultation: Using the NO TEARS tool for medication review
A 76 year old man who used to see your recently retired partner presents with his repeat medication slip. He takes six drugs regularly, five of which need reauthorising.
At least a third of patients in Britain aged more than 75 years are taking four or more drugs. Adverse drug reactions are implicated in 5% to 17% of hospital admissions. Hence the dictum “first, do no harm” becomes prescient. Doctors need to be able to critically assess a patient's treatments. Waste is substantial: £19 000 worth of drugs were returned to pharmacies over an eight week period in Gwent.
Need - Does he know why he takes each drug? Does he still need them? Was long term treatment intended? Is the dose appropriate? Has the diagnosis been refuted? Would nonpharmacological treatments be better?
Open questions - Give him the opportunity to express his views by asking questions: “I realise a lot of people don't take all their tablets. Do you have any problems?” “Can I check that we both agree what you're taking regularly?” or “Do you think your