THE MEDICAL PRESCRIPTION
– DR. JOSÉ ANTONIO MORENO SÁNCHEZ
DEPUTY GENERAL MANAGER. COORDINATION OF FEDERAL REFERENCE HOSPITALS.
HEALTH SECRETARY. MEXICO
The professional practice of the doctor requires a permanent update, in accordance with the advances in medicine, which as a science, implies innovation and creativity and research to find new drugs, treatments and diagnostic techniques that alleviate human pain, restore lost health and allow the prevention of multiple diseases that afflict the community.
Medications in medical services are also considered as a way of measuring medical behavior. The use that we make of this tool evidences the knowledge, aptitudes, ethical and human values and even the personality. With his work, the doctor makes the diagnosis, prognosis and treatment of the disease. His professional activity is directed to the sick human being. For this reason, they must show unquestionable ethical behavior at all times. The responsibility to heal another requires consistent behavior.
One of the immediate consequences of inappropriate prescription of drugs, especially antibiotics, is the appearance of germs resistant to the safest and cheapest antimicrobials, with the consequent increase in morbidity and mortality of the population and the cost of services of health. For this reason, prescription problems are a determining factor in the quality of medical care.
Starting from the premise: There are no diseases but sick people, each case must be evaluated individually, considering the particularities of each patient, in this way we will arrive at the ideal prescription that offers greater benefits, not only in their general state of health. Also the one that causes the least expense, is easy to obtain, that does not cause side effects or at least that these are minimal and tolerable and that is aimed at achieving prompt recovery.
Furthermore, the medical prescription should not be modified by outsiders who, in order to sell products, arbitrarily replace what the doctor indicated and offer or suggest other types of products or substances with some similarity and generally inducing acceptance through marketing strategies that end in the sale of their products.
Intuitive or empirical prescription can generate distrust and deteriorate the doctor-patient relationship, essential in the medical act. This, in addition, dilutes the responsibility of the professional by creating situations in which it is impossible to determine whether the prescribed medicine or the substitute could cause an undesirable reaction.
The doctor must have knowledge and take responsibility for what happens due to what is done or what is omitted. Therefore, before the prescription, the consideration that each patient requires what is specific for their health problem is imposed, never more and much less when the doctor deliberately promotes the unjustified use of a drug, influenced by interests or motivations of a personal nature or due to insecurity disguised as “security”, when in reality what it does is promote the sale, protect itself from a possible disagreement or underestimation by the patient, for “not prescribing”; as the most common example is the unjustified prescription of antibiotics at the time of discharge in the middle or late postoperative period without evidence of current infection, when in addition one or more doses were administered prophylactically.
In this order of ideas, it is necessary to update the therapeutic knowledge, but also to consider the less onerous options and the possible or alternative non-pharmacological measures, that is, to take medication only when there is no other option. It is also convenient to question whether something is always prescribed so that the patient “does not go to find another doctor” or to avoid the comment that “nothing was given to him in exchange for the money he paid for his consultation”. Also a prescription can serve to interrupt or replace the conversation between the doctor and the patient.
Today the prescription requires knowledge and technique, methodology, recommendations and guidelines for action based on the best available evidence through the systematic search for answers to questions asked about specific problems.
In summary, the fundamentals of medical prescription are: Rational scientific criteria and ethical principles, which include balanced: freedom of prescription, solidarity with the patient and awareness of their existence; respect for their autonomy, adequate instructions and avoid unnecessary expenses; Thus, to improve prescription, it will be necessary to promote access to drug information systems, use of clinical guidelines and protocols; adequate prescription formats, sufficient and adequate training of physicians; incorporation of ethical criteria in all aspects, evaluation of the effectiveness and efficacy of drugs and better health regulations, this constitutes a great challenge in which each of those involved in part that corresponds to us, we have a permanent and transcendental responsibility.