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Principles of Conservative Prescribing
Gordon D. Schiff, MD;
William L. Galanter, MD, PhD;
Jay Duhig, MA;
Amy E. Lodolce, PharmD, BCPS;
Michael J. Koronkowski, PharmD;
Bruce L. Lambert, PhD
Arch Intern Med. Published online June 13, 2011. doi:10.1001/archinternmed.2011.256
Judicious prescribing is a prerequisite for safe and appropriate medication use. Based on evidence and lessons from recent studies demonstrating problems with widely prescribed medications, we offer a series of principles as a prescription for more cautious and conservative prescribing. These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer nonurgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients' reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).
Author Affiliations: Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Schiff); Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago (Dr Galanter); and Departments of Pharmacy Administration (Mr Duhig and Dr Lambert) and Pharmacy Practice (Drs Lodolce and Koronkowski), Uiversity of Illinois at Chicago College of Pharmacy, Chicago.
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