The Garfinkel Method of Achieving Appropriate Medication Use and Individualization of Drug Therapy

Over the past decade Dr. Garfinkel has developed an original method for avoiding the inappropriate use of medications in adults and the elderly and achieving a balanced drug therapy regimen. The fundamental principals of the method are simple: minimize the number of medications being consumed and/or reduce dosages of those medications that are necessary if possible (this may mean changing a prescription to a safer alternative drug). This approach is applicable to the senior population at large as well as people with extensive co-morbidities, disabilities, dementia and a limited life expectancy.

Dr. Garfinkel’s method involves a meeting with each patient as well as the patient’s family and/or guardian, to discuss the pros and cons (benefit/risk ratio) of every medication that the patient is taking, in correlation to the patient’s age and co-existing conditions and functional, mental and cognitive status. With the patient (or guardian’s) consent, as many “non-life saving” medications as possible will be discontinued for a trial period of three months, during which the patient’s condition and response to the new drug regimen will be carefully monitored.

The Garfinkel Method – Main Features

  1. Meeting of no less than one hour with the patient in the privacy of their own home (if possible), including examination.
  2. Comprehensive geriatric assessment is performed (CGA) which forms the basis for the consultation and recommendations regarding issues such as internal medicine, geriatrics, rehabilitation, pharmacology and/or end of life concerns.
  3. Referrals, if necessary, to additional health professionals and assistive care facilities are provided (i.e. nursing, physical and occupational therapy, social workers, psychologists and dieticians, etc.).
  4. A detailed report in evidence-based medicine format is provided to the patient and/or guardian that summarize the benefit/risk ratio for each of the prescribed medications.
  5. In-depth, open discussion meeting between physician, patient, and family or guardian, after which an agreed upon comprehensive “tailor-made” therapeutic treatment plan is drawn up, taking into account individual requirements and preferences.
  6. With the consent of the patient and/or family-guardian, the Garfinkel Method of Appropriate Medication Use is implemented, taking into consideration factors such as patient’s age, co-morbidities, functional and cognitive status and personal preferences.
  7. Initial, basic recommendations are given at the end of the first meeting.
  8. A more detailed report, with additional recommendations and clarifications, is sent to the patient and/or guardian within two to three days. If needed, a formal medical evaluation certificate may be issued regarding the patient’s clinical, cognitive and functional status for the purpose of determining guardianship and/or preferred placement. At all times, priority is given to maintaining a person’s integrity and personal autonomy whenever possible.
  9. Follow-up, via meetings or telephone conversations are an integral component of the Garfinkel Method, allowing the patient to report any adverse effects to the physician and allowing the physician to monitor any change in the patient’s quality of life, functional, mental, and cognitive status, as well as patient and family satisfaction.