Medication reviews at your kitchen table

Why this has to happen in the house

Ask a patient in an office what they take and you get the list they remember. Open the actual cupboard and you find the rest: the bottle a specialist added last spring, the one stopped in hospital and quietly restarted at home, two names for the same drug from two prescribers, an expired inhaler, and a supplement nobody mentioned because it did not feel like medicine.

We go through all of it physically, bottle by bottle, including the over the counter painkillers, the vitamins and anything in a drawer beside the bed.

What we are looking for

Duplicate therapy under different brand names. Interactions between drugs prescribed by doctors who have never spoken. Doses that made sense at seventy and are too strong for the same person's kidneys at eighty two. Medications that treat the side effect of another medication. Anything sedating that is quietly raising the risk of a fall.

We also look for the opposite problem: a drug that would clearly help and has never been started, or one that was stopped and never restarted.

Fewer medicines, not more

Stopping a medication that is no longer earning its place is called deprescribing, and in older adults it is frequently more useful than adding anything new. It is done carefully, one change at a time, with a plan for what to watch and a phone call to check how it went.

Nothing gets stopped without explaining why, and nothing gets stopped behind your other doctors' backs. We write to them.

Making the routine possible

A perfect regimen that nobody can follow is not a perfect regimen. We look at whether the schedule fits a real day, whether the caps can actually be opened, whether the print is readable, whether a pill organiser or a blister pack from the pharmacy would help, and whether the cost is quietly causing someone to skip doses.