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Jason is a 38 year old man who has mental health problems, including depression and anxiety.

Jason is coming to see Dr Williams to discuss a change in his antidepressant. His usual one has been taken off the market because of growing concerns about suicide risk.

Dr Williams

Dr Williams

Thanks for coming in today, Jason. Like I said on the phone, your current medication has been withdrawn from the market. We need to put you on an alternative.



I found out about this new drug from the US on the internet and it sounds perfect for me. If I have to come off the one I'm on now, can you prescribe this for me instead?

Dr Williams

Dr Williams

Well the medication recommended as a replacement for your usual one is Zolpac*.
* a fictional drug



Recommended by who? I tried Zolpac before and it didn't deal with my anxiety anything like as well as the one I'm on now. Why can't you just prescribe me this one? I bet it's because of costs, right?

What should the doctor do...? (Select A,B or C)


Explain about clinical guidelines which recommend particular prescribing practices, and about NHS rationing of resources. Say why she believes Zolpac is the best option for him and ask if he'd be willing to try it for a month with a review in a fortnight?


Not address the issue Jason has raised about cost and insist that Zolpac is the best option for Jason's condition without further explanation?


Admit that she doesn't know enough about the US drug to prescribe it - or even whether it's licensed in the UK. Ask Jason to try Zolpac for a month and agree to find out more about the US drug for a follow-up appointment in a fortnight's time?

Dr Williams

See what the doctor did

Dr Williams decides that Jason is a well-informed patient who wants to be fully involved in his treatment. It's quite likely that he'd be reassured by having more information rather than less, so she explains that cost isn't the issue in these circumstances, but that the NICE guideline recommends prescribing Zolpac in the first instance as a replacement for his current medication.


In providing clinical care you must:
a. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health, and are satisfied that the drugs or treatment serve the patient's needs12 20
b. provide effective treatments based on the best available evidence (Good Medical Practice paragraph 16)

You must listen to patients, take account of their views, and respond honestly to their questions. (Good Medical Practice paragraph 31)

You must work in partnership with patients, sharing with them the information they will need to make decisions about their care,5 including:
a. their condition, its likely progression and the options for treatment, including associated risks and uncertainties
b. the progress of their care, and your role and responsibilities in the team
c. who is responsible for each aspect of patient care, and how information is shared within teams and among those who will be providing their care (Good Medical Practice paragraph 49)