A is for Advocate, C is for Communicate
In a healthcare world where excessive and unnecessary use of medications is common among older adults, one key strategy to push back against this trend is to self-advocacy. There is no doubt that patients who participate more actively in their healthcare—by asking questions and expressing concerns, for example—will achieve better outcomes and be more satisfied with their care. Thus, anyone who takes medications and caregivers of those individuals need to be confident to advocate for themselves regarding day-to-day decisions about medication use.
In 2019, the Lown Institute published a report Medication Overload: America’s Other Drug Problem. It states that for most patients, there is no single healthcare professional that is assigned responsibility for a person’s overall healthcare, who can keep track of all of a person’s medications and protect them from medication overload. This means that patients must be prepared to step up to the plate and be the connector between the different settings where care is received, including doctor offices and pharmacies,.
While some people might feel intimidated to question if a medicine is needed, double check if one doctor has spoken with another doctor, or admit they are not following healthcare instructions at home (such as taking a medication every day or getting more physical activity), honest and open communication is a necessary step toward better health outcomes. In fact, physicians have expressed frustration that patients often are not honest about their lifestyle, perceptions about treatments, and preferences, for example (Wall Street Journal, 3/22/25 “Doctors are just as frustrated as you by our messed up healthcare system”).
In our efforts to reduce unnecessary and harmful medication use, why is communication so important? In many instances, if you do not bring it up, it may not be discussed at all. My focus here is on medication issues, but these principles apply to all aspects of your healthcare. How do you feel about taking medications? Are you a drug “minimalist” (you would prefer to try non-drug therapies first) or are you okay with trying a medication? Have you stopped taking a medication because it is too expensive or causing a side effect? Or perhaps you don’t think the medicine is helping, but the doctor never specifically asked about it and you didn’t think to bring it up. One of the barriers to “deprescribing” is that neither doctors nor patients make it a regular part of office visit conversations.