Personal Views

Symptomatic prescribing reappraised

BMJ 1996; 313 doi: (Published 23 November 1996) Cite this as: BMJ 1996;313:1338
  1. Peter Hays

    At the University of Alberta we focus our history, examine pointedly, diagnose specifically, eradicate the cause, and educate the patient prophylactically. For completely ideal care we should also include (what was omitted from the dreamlike opening sequence) symptomatic treatment, the judicious management of distress.

    Until recently symptomatic treatment was virtually our entire stock in trade, but the profession prospered. Then science and serendipidity provided us with a range of specifics, and we began to dismiss other treatments as merely symptomatic and to note their capacity to obscure diagnosis or to cause dependence. I have seen calamities arising from thoughtless symptomatic prescribing and, because I am a fastidious academic, I shudder at the memory.

    Why, then, do I not shudder when I look at my own prescribing patterns and those of the senior professors who are my closest colleagues?

    Lorazepam is recommended for the short term relief of anxiety neurosis. Five years is commonplace at this centre, mostly not for anxiety neuroses. Diazepam should be discontinued after a few weeks at the most. Twenty five years does not raise an eyebrow round here. I draw a veil over amphetamines and congeners; symptomatic medicine thrives where you would least expect it.

    What happens …

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