Thank you for this honest appraisal of what it’s like to be a prescribing physician.
In the messy world of real people, there can’t be a one-size-fits all answer. Meds may be the best choice for some people. They’re legal and a lot of people want them. But all people merit true informed consent: What is the medicine actually doing? What are the risks? What are the alternatives?
In my world of primary care, I deal mostly with the mild to moderately distressed, the anxious and sad and overwhelmed, and here I think the role of medication is even murkier.
If we prescribers were to discuss the following questions with our patients prior to initiating drug therapies:
–Is the short-term, marginal benefit of this medication worth the known risks and costs?
–Is it being used as a last resort rather than a first one?
–Is it being prescribed for short term stabilization (which research supports for some meds) rather than long-term use (for which research shows worsening outcomes and comorbidities)?
–At the moment of initiation of drug therapy, am I providing the patient with a plan and appropriate expectations for withdrawal?
If all prescribing physicians were to ask these questions with every patient, then I think we would still find patients for whom medications were appropriate. But I’m convinced there would be a dramatic overall reduction in psychotropic prescribing and its attendant iatrogenic harm.
Thanks again for your post.
Thank you for this honest appraisal of what it’s like to be a prescribing physician.
In the messy world of real people, there can’t be a one-size-fits all answer. Meds may be the best choice for some people. They’re legal and a lot of people want them. But all people merit true informed consent: What is the medicine actually doing? What are the risks? What are the alternatives?
In my world of primary care, I deal mostly with the mild to moderately distressed, the anxious and sad and overwhelmed, and here I think the role of medication is even murkier.
If we prescribers were to discuss the following questions with our patients prior to initiating drug therapies:
–Is the short-term, marginal benefit of this medication worth the known risks and costs?
–Is it being used as a last resort rather than a first one?
–Is it being prescribed for short term stabilization (which research supports for some meds) rather than long-term use (for which research shows worsening outcomes and comorbidities)?
–At the moment of initiation of drug therapy, am I providing the patient with a plan and appropriate expectations for withdrawal?
If all prescribing physicians were to ask these questions with every patient, then I think we would still find patients for whom medications were appropriate. But I’m convinced there would be a dramatic overall reduction in psychotropic prescribing and its attendant iatrogenic harm.
Thanks again for your post.
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