Introduction

Reviews

Avoiding Unnecessary Prescriptions

Timothy B. McCall, M.D.

Writing a prescription is one of the easiest and most natural things a doctor can do. Studies show that 75 percent of visits to the doctor result in a prescription for at least one drug. Some doctors give a least one prescription to virtually every patient who walks in their office.

All this might be fine is drugs were perfectly safe. They are not. There has yet to be a drug invented that doesn't cause side effects. This applies equally to over-the-counter drugs. One of the most common reasons for hospitalization is a reaction to a prescribed medicine. Drug reactions in the hospital are also common.

As Franz Kafka wrote, “It is easier to write a prescription than to come to an understanding with the patient.” It takes a doctor perhaps 30 seconds to write a prescription, 10 minutes or longer to explain why one is not needed. Given that many office appointments are less than 10 minutes these days, you can see the problem.

Handing you a prescription is a shorthand way of saying Your appointment is over. It's also a way for the doctor to get you out of his or her hair—by answering the question What are you going to do for me, Doc? Given time constraints, it's often the best and most concerned physicians who take the time to not write a prescription.

Here are some things to keep in mind, when evaluating whether is your doctor is prescribing more drugs than necessary:

• Sometimes the best drug is no drug. Many conditions routinely treated with drugs can be successfully managed without them. High blood pressure, elevated cholesterol levels and adult-onset diabetes, for example, can all sometimes be treated with safer, non-drug therapies. (Note: If you are taking medicines, do NOT stop them without talking with a doctor first.)
• Once a drug is started, doctors may continue to prescribe it, whether you need to remain on it or not. Many doctors automatically renew prescriptions without reassessing the need for the treatment. Many doctors seeing patients for the first time will automatically continue all the drugs their former doctor had prescribed without evaluating whether the drugs are necessary or appropriate. I have seen instances where people have remained on drugs for thirty or forty years—sometimes prescribed by a series of doctors—that were never needed in the first place.
• Doctors sometimes prescribe unnecessary drugs due to their fear of lawsuits. Many doctors prescribe drugs even when they think there isn't much chance they'll help you, because they worry that if they don’t, they may later be charged with negligence. There may be circumstances when such behavior is warranted, as when the drug is cheap and safe or when the situation is grave but, in general, “just in case” drugs aren't a good idea. Given the litigious atmosphere in American medicine, when a doctor says “just in case,” it can mean just in case you try to sue me.

When there is only a small chance a drug will help you, you may or may not want to try it. At the very least, you have the right to be involved in the decision. If a doctor thinks you have only a small chance of benefiting, that doctor should tell you, so that together you can weigh the risks and benefits and make a decision. If the you decide to forgo the drug, the doctor can warn you which symptoms might indicate that you're getting worse and need to be seen again.

Next: How Drug Marketing Leads to Inappropriate Prescribing

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