english.prescrire.org > Positions > Overmedication > The constant practitioner

Theme: Overmedication

We’ve got a pill for just about everything these days. Healthcare professionals are under pressure to prescribe medications which may do no good, and might even do much harm. How can we resist the urge to overmedicate existence?

The constant practitioner

Faced with a patient’s suffering, healthcare professionals must first listen, discuss and explain, and then offer the treatment whose harm-benefit balance is the most acceptable. Especially when the patient thinks that a drug is a miracle cure for whatever is ailing him or her at the moment: a little feel-good pill, with no adverse effects.

Healthcare practitioners need an awful lot of constancy to resist the urge to take the easy way out by prescribing or recommending a drug. Especially when the patient thinks that the drug is a miracle cure for whatever is ailing him or her at the moment. Especially when the media and opinion makers are always pushing us to believe in that miracle: a little feel-good pill, with no adverse effects.

Why, then, bother to resist? Because healthcare professionals know that all treatments can cause adverse effects, and that the potential harm can outweigh the expected benefits. And also because the healthcare professional’s first duty is to "do no harm".

Like the gardener who, season after season, learns to seek harmony with nature, conscientious healthcare professionals should cultivate the health of patients who come to them seeking relief from their ills.

Healthcare professionals see too many patients with minor complaints, such as sleep disorders, who have fallen into the trap of dependence on psychotropic drugs, while other treatments, with or without drugs, would probably be more effective. It is difficult to explain to these patients that the risks of the treatment they were prescribed outweigh the benefits. Nevertheless, certain studies suggest it is worth taking the time to explain, as it can help the patient shake off his or her dependence.

There are many non-drug options for complaints like sleep disorders. Above all, time must be taken to explain the physiology, how and why things can go wrong, and the possible consequences. This investment of time is important for the patient’s future well-being, and can help him or her to get back on firm ground. A drug can sometimes help during a particularly difficult period. But a number of precautions should be taken from the outset, such as prescribing the lowest effective dose, to be taken intermittently, with treatment withdrawal planned from the outset, and drugs to be dispensed in small quantities.

Faced with a patient’s suffering, healthcare professionals must first listen, discuss and explain, and then offer the treatment whose harm-benefit balance is the most acceptable. With all the constancy that it takes to avoid overmedicalising or overmedicating the ups and downs of life.

©Prescrire 2008

Prescrire Int 2008; 17 (96): 134.