I think it's always easy to sit around and Monday-morning-quarterback other doctors' decisions. Polypharmacy is everywhere, and griping about how "that doctor" does this or that thing that we NEVER do is not the most constructive of responses to it.
Agree.
But I believe this problem exists on a spectrum.
Most patients IMHO (at least where I've been at), in general there's more attendings than not that give out too many benzos and opioids. I do though believe there are places where maybe they're not given out enough.
There will always be patients who are outside the norm. I listed a few from my experience. I have one patient who has panic disorder that's actually controlled well on gabapentin. I wasn't the one that put her on it, but she's already on it, it stopped her panic attacks, and attempts to put her on an SSRI have not worked.
But from my own experience, there's not enough good documentation in many of the weird cases. If for example, in the case above, the doctor wrote down that 3 SSRIs and 2 SNRIs were tried and failed, and that the use of gabapentin used only after several attempts on the more conventional algorithm were tried and failed, then I'd be more comfortable with these weird cases. Unfortunately I usually don't get that documentation with my new patients, nor do the patients remember what the doctor's decision making process was.
I have about 10 patients in my moonlighting gig where I really don't know if their current polypharmacy is justified, but since the previous doctor didn't document well why he chose those meds, I'm caught in an uncomfortable position of holding the angry wolf by the ears. I don't want to hold on, but I don't want to let go either.
E.g. I have a few patients on Clozaril, but the previous doctor did not document which other antipsychotics were tried and failed. I don't know if another antipsychotic was tried that would not have as many side effects. They are currently to the point where their ANCs only have to be checked once a month. If I screw around with that, and if they indeed needed the Clozaril, well then I'd be consigning them back to the uncomfortable weekly monitoring.
I also have a patient on over 7 psychotropics--3 of which are at megadoses. I'm trying to wean her off of some of them.
I also got a sex offender put on weekly doses of depot-provera. That medication is only supposed to be given once every 3 months, so, the previous doctor put him on 12x the manufacturer's recommended dosage for this medication whuch was being used for unconventional and non-FDA approved uses anyway. I've tapered down his dosage down now to one shot every 2 months, and still no changes in his behavior, so what the previous doctor was thinking, I don't know. He didn't document why he did what he did.
Bottom line, opioids and benzos, while on occasion justified, if given out should have good documentation as to why they are being given, and IMHO should not be used as a long-term solution to a problem. Even better, IMHO these meds should not be given without an exit strategy, or without an occasional weaning off period to prevent tolerance and possible dependence on these meds.