Request for tranquillisers

Choose what the doctor should do when a patient asks for a further prescription of tranquillisers during a remote consultation.

Case study

Background 

Dr Best works for an online pharmacy, assessing patients’ requests for private prescriptions. 



Scenario

Dr Best reviews the questionnaire submitted by a 28 year old patient, Lauren, who has requested painkillers for acute back pain. Lauren has indicated that the pain was the result of an accident – she tripped and fell in the street.

Dr Best is concerned about the request since the painkillers Lauren has asked for are very strong. He also notes from the pharmacy’s records that Lauren has received the same medication for the same problem on three previous occasions. Dr Best is concerned that this may indicate an underlying issue – with the injury, Lauren’s pain management or possibly medicines misuse.

What should the doctor do?

  1. Prescribe the painkillers to help Lauren with her immediate pain, but tell her that next time she should see her own GP?
  2. Decline to prescribe and advise Lauren to seek face-to-face medical advice about her back problem?
  3. Contact Lauren asking for further information about her injury, current pain levels and previous prescription requests?

What did the doctor did

As Lauren’s request was submitted online, Dr Best can’t discuss the request with her or carry out an examination. He also has limited opportunities for follow-up. As there is doubt about the cause of Lauren’s pain, which he isn’t able to resolve, Dr Best decides not to prescribe painkillers for her. He recommends that she make an appointment to see her GP or another doctor who can assess her condition and treatment needs appropriately.

What the doctor had to consider

  • Remote consultations (online or via telephone or video link) can improve patient access to advice and treatment, but they are not always an appropriate alternative to seeing a patient face-to-face.
  • When consulting remotely, it’s important to consider the limitations of the medium by which you are communicating with the patient.  You should not prescribe unless you are satisfied that you have sufficient information to do so safely.