Treatments: Limits and interactions

What falls outside

Recognising the limit does not weaken the practice: it is what makes it defensible. And it does not mean abandoning the patient, because accompaniment stays possible in almost every case.

A serious acute picture

medical emergency, always

Suspicion of an unidentified serious process

refer before treating

Treatment prescribed by another professional

never withdrawn or suggested to be

What you can do

accompany, relieve and support

Common mistake: Suggesting a patient stop their medication. It is never your place, and once is enough for the consequence to be serious.

Interactions to always ask about

Herbs are not harmless just for being natural. There are four drug groups to be especially careful with, and to ask about before recommending anything.

Anticoagulants

careful with anything that mobilises blood

Diabetes medication

watch for changes in blood glucose

Psychiatric medication

frequent and poorly studied interactions

Oncology treatments

coordinate with the medical team

Common mistake: Asking «are you on any medication?» and accepting a quick no. Ask about supplements and over-the-counter herbs too.

What do you do in each situation?

• Tension headache in a healthy person on no medicationTreat as usualTreat with precautions and coordinateRefer before treating
• Joint pain in an anticoagulated patientTreat as usualTreat with precautions and coordinateRefer before treating
• Significant unexplained weight loss over three monthsTreat as usualTreat with precautions and coordinateRefer before treating
• Anxiety in someone on stable psychiatric treatmentTreat as usualTreat with precautions and coordinateRefer before treating
• Slow digestion in someone taking a stomach protectorTreat as usualTreat with precautions and coordinateRefer before treating
• New bleeding the patient has not had looked atTreat as usualTreat with precautions and coordinateRefer before treating

A patient improves a lot and asks whether they can stop their medication. What do you answer?

1. That yes, if they feel well
2. That it is decided by whoever prescribed it, that you are glad to support them if they raise it with that professional, and that you carry on with your part
3. That they should taper it down on their own

How do you talk about expectations at the start of a long treatment?

1. By promising results so the patient does not drop out
2. By saying nothing, so as not to condition them
3. By saying what is expected to change, roughly when, and at what point you will review if it does not

Order the check before proposing a plan.

1. Rule out red flags requiring referral↑↓
2. Ask about medication, supplements and herbs↑↓
3. Ask about pregnancy and relevant history↑↓
4. Check that the principle does not clash with ongoing treatment↑↓
5. Explain the plan, the timeframe and the review point↑↓