The law of diminishing returns
The law of diminishing returns, first described by economists to explain why, beyond a certain point, additional inputs produce smaller and smaller outputs, offers insight into many situations practitioners stumble upon in clinical practice. In everyday experience, this law is expressed, as “the gain is not worth the pain.”

Still, it could be argued in clinical practice, that we should do everything possible to reduce the risk of future adverse events. There are several other good reasons to do so. First, the larger the number of medications prescribed, the less likely they will be taken consistently and according to directions. In addition, the costs and the number of side effects increase linearly with each additional medication, and the number of potential drug-drug, drug-food, and drug-disease interactions increases exponentially. As a rule of thumb, once the number of medications reaches approximately five, the probability of adverse events becomes high enough to offset any positive effects of additional medications.

Clinicians need to help patients, particularly those with chronic illnesses, deal with the increasing workload of looking after themselves, according to Professor Victor Montori of the Mayo Clinic in the USA, writing in the August edition of Australian Prescriber. “Current treatment guidelines for doctors tell them to treat their patients to reach certain targets, such as a healthy blood sugar or cholesterol,” says Professor Montori.

“If a treatment involves more medicines, this can mean the patient needs to do more intensive self-monitoring and self-management. They have to make time for more treatments, tests, and visits to health professionals,” says Professor Montori.

“For example, a patient with diabetes may be expected to manage their diet, activity, take their medicines, and check their blood sugars – which becomes very time-consuming. Some patients may be spending more than two hours a day managing their condition,” he writes.

Benefits from lifestyle measures or medicines need to be balanced against the burden of all this treatment, says Professor Montori, and clinicians should involve patients in the prioritising of goals when it comes to their treatment.