Intended for healthcare professionals

Student Education

The medic's guide to prescribing Effective prescribing

BMJ 2007; 335 doi: (Published 01 July 2007) Cite this as: BMJ 2007;335:0707270
  1. Claire Meager, fourth year medical student1,
  2. Philip A Routledge, professor1
  1. 1Department of Pharmacology, Therapeutics, and Toxicology, Wales College of Medicine, Cardiff University

How often have you thought about the importance of and the processes involved in choosing the most effective drug for your patient? Claire Meager and Philip A Routledge help you find out

I will not provide treatments that are pointless or harmful, or which an informed and competent patient refuses. I will help patients find the information and support they want to make decisions on their care

A new Hippocratic oath, 2004

When it comes to choosing the most appropriate drugs for our patients, there unfortunately isn't a concept of a must have drug or indeed a one size fits all regimen of treatment. Instead, each decision about treatment is made according to a number of different factors, such as proved efficacy, cost effectiveness, and patients' preferences. Together these constitute the idea of rational prescribing. (This concept was introduced in article one of this series.) This article explains which drugs we should be giving to our patients, focusing on fundamental concepts while also giving a few specific examples.

In a perfect world patients would not need any drugs, and one stop treatments would be the answer. This is often the panacea of medical treatment-for example, the idea of islet cell pancreatic transplantation for diabetes mellitus rather than daily injections of insulin or multiple hyperglycaemia drugs. For most chronic conditions, however, such as ischaemic heart disease, hypertension, and diabetes, long term treatment with drugs is essential. And as the population ages, patients with multiple comorbidities will need ever increasing numbers of treatments.

Drugs are the mainstay of therapeutic interventions for acute and chronic conditions, whether intended to prolong life, treat symptoms, or cure disease. When making the decision about which class of agent or the most appropriate drug for your patient you should consider efficacy and clinical effectiveness, safety, and cost …

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