Should medical students be taught rational prescribing?BMJ 2003; 326 doi: https://doi.org/10.1136/sbmj.030489 (Published 01 April 2003) Cite this as: BMJ 2003;326:030489
- Robin Ferner, consultant clinical pharmacologist and honorary senior lecturer1
- 1Department of Medicine, City Hospital, University of Birmingham
The famous 19th century pathologist Virchow dismissed therapeutics contemptuously, saying that only by combination with physiology could it rise to be a science, ‘which today it is not.’1 A J Clark, a professor in Edinburgh, after the first world war, wrote that, ‘The vital information as to what a drug does when given in therapeutic doses in disease is scanty in most cases, and absent in very many.’1 We are gradually making progress, but many medical schools no longer teach the skills, knowledge, and attitudes needed to make good prescribing decisions.
Will the treatment meet its purpose?
The first skill for a rational prescriber is to decide the aim of prescribing. Is it palliation of symptoms, cure of a disease, or the prevention of some adverse consequence? For sore throats, antibiotic treatment might reduce the incidence of quinsy but is unlikely to be as effective as aspirin for pain relief.2 Reconciling the prescribers view with the patients can be hard, and we also need to acquire the attributes to achieve this.
The next skill is deciding whether the treatment is likely to achieve the aim. A whole series of therapies is now known to be ineffective or frankly dangerous. These range from the application of leeches in pneumonia to the use of the monoclonal antibody HA-1A to treat Gram negative septicaemic shock.3 But information on …