Saturday, January 22, 2022

Comments by Mark Foster, DO

Showing 1 of 1 comments.

  • 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.