Intended for healthcare professionals

Primary Care 10-minute consultation

Using the NO TEARS tool for medication review

BMJ 2004; 329 doi: (Published 19 August 2004) Cite this as: BMJ 2004;329:434
  1. Tessa Lewis, general practitioner (
  1. 1 Carreg Wen Surgery, Blaenavon, Torfaen NP4 9AF


    A 76 year old man who used to see your recently retired partner presents with his repeat medication slip. He takes six drugs regularly, five of which need reauthorising.

    What issues you should cover

    At least a third of patients in Britain aged more than 75 years are taking four or more drugs. Adverse drug reactions are implicated in 5% to 17% of hospital admissions. Hence the dictum “first, do no harm” becomes prescient. Doctors need to be able to critically assess a patient's treatments. Waste is substantial: £19 000 ($35 000; €29 000) worth of drugs were returned to pharmacies over an eight week period in Gwent.

    Need and indication—Does he know why he takes each drug? Does he still need them? Was long term treatment intended? Is the dose appropriate? Has the diagnosis been refuted? Would non-pharmacological treatments be better?

    Open questions—Give him …

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