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Personal Views

A doctor's dilemma

BMJ 1997; 315 doi: (Published 30 August 1997) Cite this as: BMJ 1997;315:553
  1. Margot Nelson-Owen, prison medical officer
  1. Cardiff

    It is difficult to criticise the working practices of other doctors. You leave medical school with a sense of belonging to a family of time honoured physicians who have given their lives to healing the sick and treating the needy. The Hippocratic oath tells us to be loyal to the profession of medicine, and just and generous to its members. You learn about the fundamentals of pharmaceutical practice—first do no harm. It is this last statement with which my conscience is struggling, and which is responsible for the dilemma I face.

    There is a real problem out there—and it is not what it seems. I used to think—those junkies, they are no-hopers. How can you help people who don't care, or who don't want to help themselves? The reality is different. General practitioners and community drug team doctors have a lot to answer for.

    I see many 17 year olds who come into prison on genuine repeat prescriptions of all sorts of addictive drugs such as diazepam, temazepam, methadone, dihydrocodeine—this can't be right. …

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