Need and objectivity
You should prescribe medicines only if you have adequate knowledge of the patient’s health and you are satisfied that they serve the patient’s needs.
In Decision making and consent,5 we say:
49. If a patient asks for treatment or care that you don’t think would be in their clinical interests, you should explore their reasons for requesting it, their understanding of what it would involve, and their expectations about the likely outcome. This discussion will help you take account of factors that are significant to the patient and assess whether providing the treatment or care could serve the patient’s needs. If after discussion you still consider that the treatment or care would not serve the patient’s needs, then you should not provide it. But, you should explain your reasons to the patient and explore other options that might be available, including their right to seek a second opinion.
You must not prescribe medicines for your own convenience or the convenience of other health or social care professionals (for example, those caring for patients with dementia in care homes6).
See The use of antipsychotic medication for people with dementia: Time for action (Department of Health, 2009), which reported that ‘around 180,000 people with dementia are treated with antipsychotic medication across the country per year… use at this level equates to an additional 1,800 deaths, and an additional 1,620 cerebrovascular adverse events, around half of which may be severe, per year’, and NICE clinical guideline 42: Dementia. The National Prescribing Centre website and the joint NHS Institute and Dementia Action Alliance’s Call to action: the use of antipsychotic drugs for people with dementia also contains guides, case studies and other materials to support good prescribing practice and alternative care strategies for patients with dementia.
Prescribing for yourself or those close to you
Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.
Controlled medicines present particular dangers, occasionally associated with drug misuse, addiction and misconduct. You must not prescribe a controlled medicine for yourself or someone close to you unless:
- no other person with the legal right to prescribe is available to assess and prescribe without a delay which would put your, or the patient’s, life or health at risk or cause unacceptable pain or distress, and
- the treatment is immediately necessary to:
- save a life
- avoid serious deterioration in health, or
- alleviate otherwise uncontrollable pain or distress.
If you prescribe for yourself or someone close to you, you must:
- make a clear record at the same time or as soon as possible afterwards. The record should include your relationship to the patient (where relevant) and the reason it was necessary for you to prescribe.
- tell your own or the patient’s general practitioner (and others treating you or the patient, where relevant) what medicines you have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody close to you) they object.