The single most useful question in a polypharmacy consultation is temporal. Not what is the symptom, but what was prescribed in the weeks before it began.
A new symptom in an older adult on several drugs is more often an adverse effect than a new disease, and the date of onset usually gives it away. Constipation three weeks after starting iron. Aching legs a month after a statin. Restlessness after a course of steroids. The diagnosis is in the sequence, and it is invisible unless you look for it.
So build the habit: when a new complaint appears, open the medication list and read it by start date rather than alphabetically. If the timing fits, consider stopping or reducing the suspect drug before adding a second one to treat the symptom.
- Sort the medication list by start date whenever a new symptom appears.
- Ask explicitly: did anything change in your tablets in the month before this started?
- Trial withdrawal of the suspect drug before adding a new one, where the original indication allows it.
- Write the reason for stopping in the notes, so a later prescriber does not simply restart it.
- Include over-the-counter and traditional medicines in the list — in Indian practice these are frequently the missing item.
Why it matters
The commonest cause of a new symptom in a patient on eight drugs is the eighth drug.
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