Good practice in prescribing medicines
Should doctors prescribe medicines for family, friends or themselves?
By Dr Brighton Chireka
TIMES have changed in prescribing medicines and I think it’s for the better. This reminds me of 1998 when I was a junior doctor and I would see my senior colleagues prescribing medicines for their families, friends and even themselves. These senior colleagues had free access to medicines at the hospital and all they needed was to sign in a book and they would get any medication they wanted. I remember seeing my senior colleagues walking into a pharmacy and asking for a prescription pad so that they could prescribe for their loved ones. I am glad to say it is unheard of now as it is unethical and bad practice as well.
Today I get a lot of requests from close friends and social media “friends” for medication which, unfortunately, I cannot prescribe. I am at pains to try and explain why it is unethical and bad practice as well as dangerous to do so. I hope this article will be read and shared by a wider audience so that doctors are not inundated by these inappropriate requests. We may sound uncaring and not sympathetic to desperate people making these requests but there are reasons why it is inappropriate to prescribe medicines under those circumstances.
I will start by looking at good practice in prescribing medicines as recommended by reputable registration councils like the General Medical Council (GMC) in the UK. A doctor should prescribe medicines only if they have adequate knowledge of the patient’s health and are satisfied that they serve the patient’s needs.
The doctor must have or should take adequate medical history and must find out if the patient is taking any other medicines or if he/she had adverse reactions to medication in the past. There are certain drugs that interact with each other and must not be given together and this also includes alternative remedies, illegal drugs that the patient may be taking. The full medical conditions of the patient must be assessed and past medical and current history must be known before any medication can safely be prescribed.
A doctor must discuss different treatment options with the patient and reach an agreement on the best option for the patient. The discussion must include the likely benefits, risks and burdens, including serious and common side effects. Patients must be made aware of what to do in the event of a side effect or recurrence of the condition. It should be made clear as to how and when the medicine should be taken and how to adjust the dose if necessary. The duration of treatment must be clear and arrangements for monitoring, follow up and review must be put in place.
Sometimes patients do request treatments that a doctor considers inappropriate, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after an open discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. The doctor should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
Patients must understand instructions regarding how to take their medicines and must be encouraged to ask questions to clarify anything that is not clear to them. Patients must also be honest with their doctors by revealing any medicines they are taking including recreational drugs or herbal medicines.
The above are some of the good practices in prescribing medicines and must be done in all circumstances unless it is an emergency or life threatening situation such that following of good practice may compromise the health of the patient.
This brings me to the main reason for writing this article. Should we prescribe for family, friends and ourselves? If one is to look at good practice, one will see that we should not be doing that. There are dangers associated with self-medication or prescribing controlled drugs to family, friends and colleagues. There is risk of addiction and misuse of the medication by doctors and relatives as well as friends.
There is no record keeping and inadequate communication with regular General Practitioner (GP). The friend may not reveal a complete medical history resulting in a high potential for drug interactions which can be fatal or prescribing of drugs that may worsen other medical conditions the friend may have. We know that most of us doctors struggle to remain objective when trying to self-diagnose and self-treat. We feel this even more when dealing with family or close friends.
This reminds me of a time when my daughter developed high temperature. I knew it was a viral illness that was going to end in a few days but I could not trust my judgement when it comes to my family. I then took my daughter to her GP and was happy to be reassured that it was a viral illness and there was no need for antibiotics. I know that I would not have forgiven myself if I had sat whilst my daughter’s health was deteriorating.
Doctors need empathy in their work but emotional attachment is not good. As a GP, I see several patients and they present with a variety of problems. Some come to see me to hear bad news that they have cancer and some come to hear good news that they have been cured. I have to be prepared for each patient and not let the situation of the previous patient affect my next patient.
I like what my colleague Dr Achyut Valluri said, and I quote; “Having empathy is good as a doctor; having an emotional attachment is not – it’s bound to affect your judgement or focus. Being husband, dad and son is responsibility enough, without having to be the doctor too! And I know I’d never forgive myself if I missed an appendicitis that one time my daughter complained of a tummy ache.”
Dr Valluri’s statement resonates well with me and I agree that doctors should not prescribe for themselves and their loved ones. It is also dangerous, irresponsible and bad practice to prescribe any medicine without having access or taken a full medical history of the patient involved.
I know that there are very rare occasions when doctors have to “break the rule” and this only happens when no other person with the legal right to prescribe is available to assess and prescribe without a delay which would put your, or the patient’s, life or health at risk or cause unacceptable pain or distress, and the treatment is immediately necessary to: save a life, avoid serious deterioration in health, or alleviate otherwise uncontrollable pain or distress.
As usual I urge you to share this article; comment on it, as I also learn from your experiences but remember to see your regular doctor to discuss your medical problems.
You may want to read the following related articles on medicines;
This article was compiled by Dr. Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog at www.docbeecee.co.uk/blog
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal.
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