Many doctors over-prescribing instead of using drug-free conservative approaches
With almost half of all Americans using a prescription in the past month according to the Centers for Disease Control and Prevention, experts are worried about the rampant practice of over-prescribing.
And other statistics related to the issue are of grave concern:
- The majority of patients under age 65 years receive at least one prescription drug annually.
- Four million prescriptions for long-acting painkillers are written every year; painkillers are the most commonly prescribed drugs in America.
- In 2007 there were 11,500 deaths related to painkillers; experts say the drugs do not always deliver substantial pain relief, and carry a high risk of addiction, side effects, and death.
Gordon D. Schiff, M.D., from Harvard Medical School, Boston, with colleagues in the medical and pharmacy divisions of the University of Illinois at Chicago, outlines a series of steps in their published report that appeared Archives of Internal Medicine,one of the JAMA/Archives journals, that can be taken to rein in prescription writing. “Although others have used labels such as healthy skepticism, more judicious, rational, careful, or cautious prescribing,” they write, “we believe that the term conservative prescribing conveys an approach that goes beyond the oft-repeated physician’s mantra, ‘first, do no harm.’”
Dr. Schiff’s recommendations include:
- Determine if other interventions besides prescription drugs would be more helpful;
- Use discernment when prescribing to determine the best choices available and avoid using multiple prescriptions;
- Be more vigilant about adverse side effects, including patients’ potential drug reactions, instructing them about the warning signs, and being more discerning about choosing prescriptions that make a patient more prone to withdrawal symptoms or relapse;
- Be judicious about claims being made about any new drug’s benefits, perhaps waiting until it has a proven track record, and ensuring it targets the core issue;
- Collaborate with patients on a shared agenda for more effective treatment, such as encouraging them to use skepticism about promises made in advertisements and re-think demanding those drugs, and encouraging them to be more compliant with suggested approaches to treatment;
- Consider foremost the long-term effects of prescription drug treatments and consider different therapies that are less likely to cause chronic health issues.
The experts recommend taking greater care when deciding to prescribe a drug, especially one that is new or not well understood. “While clinicians must always weigh the benefits of conservative prescribing against the risks of withholding potentially needed medications, at the very least we should seek to shift the burden of proof toward demanding a higher standard of evidence of benefit before exposing patients to the risks of drugs.”
