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Intended for healthcare professionals

Opinion Taking Stock

Rammya Mathew: Prescribing isn’t a single act—getting it right requires time and effort

ݮƵ 2024; 384 doi: (Published 06 February 2024) Cite this as: ݮƵ 2024;384:q279
  1. Rammya Mathew, GP
  1. London
  1. rammya.mathew{at}nhs.net
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Despite working as a GP for close to 10 years, I still find it astonishing how life changing drugs can be. For many of our patients, drugs are the difference between being incapacitated with illness and leading a more “normal” and fulfilling life. The effects of drugs can be tangible and obvious—for example, in patients with inflammatory arthritis, epilepsy, or thyroid disorders. But the effects can also be entirely invisible: we don’t see the amputation, stroke, or heart attack that never happened through the good use of medicines.

While therapeutics is such an important and impactful part of what we do as doctors, it surprises me how it’s become so deprioritised in the clinical consultation. How much time do we spend explaining medicines to patients, counselling them about how they work and how they should be taken, adjusted, and monitored? In my experience, this lack of attention to detail is reflected in my conversations with patients about compliance and adherence.

For example, I’ve come across patients who take their evening metformin only if they’ve had a heavy meal that night or who decide to take their antihypertensives every second or third day. We might not think it important for patients to understand the pharmacology behind the drugs they take, but a lack of understanding can affect outcomes. Although we put a lot of effort into getting the right diagnosis and identifying the right treatment for patients, this isn’t always replicated when it comes to prescribing and helping them get the most out of their medicine—which feels wasteful and counterintuitive.

Growing trend

In recent years I’ve seen a growing trend for patients who are seen in hospital outpatient clinics not to have medicines prescribed at all but for a recommendation to be made back to their GP to initiate this instead. When drugs hold such power to be truly life changing for our patients, it concerns me that it’s becoming common practice to devolve this responsibility.

I understand the time pressure that everyone is working under, but GPs also don’t have time on their hands to counsel patients about the numerous drugs recommended by hospital physicians—many of which we don’t routinely prescribe ourselves. If the task is passed on there’s a risk that it will be done poorly or not at all, and patients lose out as a result.

If capacity is the issue, I would argue that we need to make better use of pharmacists within our services to see through the process of safe prescribing. Pharmacists, particularly those outside the hospital setting, are being tasked with all sorts of clinical roles that don’t centre on prescribing, when in fact the burden of prescribing is huge and there’s a real need for their continued support in this area.

The bottom line is that prescribing isn’t a single act: getting it right requires time and effort, which often means multiple appointments. This needs to be factored in and resourced so that patients can reap the benefits of medicines and be safeguarded against potential harms.

Footnotes

  • Competing interests: None.

  • Provenance and peer review: Commissioned; not externally peer reviewed.