I can tell you from real professional experience across the last 15 years that: Caution: I said the above was my experience and I am being 100% honest in my estimates on that. I do not know if my estimates apply to a total population of all doctors in the UK. I read parts of three key guidance documents (of 34) almost every day over the last 8 months. Over the last 5 years on average I would have read ...
In this post I will spend some time understanding the power of medications, then extract some fundamental principles from the GMC’s guidance on prescribing (April 2021). I then analyse two real-world scenarios in prescribing that I have experienced and reference each against the GMC’s guidance. [The scenarios do not contain information that identifies any patient. Both scenarios are common in medical practice] A patient requests a medication to treat side-effects of another medication (clozapine) that he is established on. This ...
As a result of recent media publicity about surgeon’s performance, I began thinking that I rarely if ever see any stories in the media about psychological harm caused by failures in psychiatric treatments. I reflected on this and thought, that with surgery it is easier to spot errors in retrospect because patients can be subject to x-rays, scans and other tests to show physical things that went wrong procedurally. But in psychiatry where we use medications (or occasionally ECT), there ...
Back in the 1990s, diagnostic criteria existed for sure. We had ICD-9 as our main diagnostic manual. My recollections from around that time was that the criteria were hardly ever referenced. How it worked was, the consultant psychiatrist would declare diagnosis or differential diagnoses without actually stating which criteria were met from available evidence. As a junior trainee, I had no say in the matter. In one adolescent psychiatry service around 1993, the consultant psychiatrist and a consultant psychologist stated, ...
All health service personnel who deliver or are involved in delivering frontline health services are required to document their work. This is must be at the core of all health care. Follow-up topics: The Documentation Dilemma (Aug 2024), High level documentation practices (Oct 2024) and Decision-making (Oct 2024). What does documentation mean? Documentation as a word has several meanings depending on the context in which it is used. Here are a few common interpretations: Documentation in health services Of the ...
Polypharmacy is the use of multiple medications by a patient, particularly when too many forms of medication are used by a patient, when more medications are prescribed than are clinically warranted, or when all of an individual’s medications are not clinically necessary. While there is no set number of medications that defines polypharmacy, the term is often used when a person uses five or more medications concurrently. However, polypharmacy can be present for someone on three medications, depending on the ...
In the last 3 years I’ve received many requests for medication reviews. Interestingly most of those requests came from nurses; not pharmacists, not social workers and not other doctors. Underlying the requests were generally some concern that patients were not improving. Not a single request was about medication toxicity, or polypharmacy. Nurses tended to hint at the patient requiring higher doses or demand prescribing more medications. That body of experience led me to investigate the concept of medication reviews. All ...
In the UK, the terms “off-label” and “off-licence” prescribing are often used interchangeably, but they refer to slightly different concepts. The General Medical Council wisely unified both concepts to the term ‘unlicenced prescribing’ . It does not mean ‘illegal prescribing’. Most unlicenced prescribing in the practice of medicine happens in psychiatry. Why is unlicenced prescribing a big deal? In a nutshell, it is because when a medication is used outside of it tested development parameters special precautions ought to be ...
To ordinary people risk is something felt and seen. If something is dangerous you expect normally to be aware of it, like the edge of a cliff or an open manhole on some pavement. This post should be read together with Risk – how is that to be managed? If a large dog is growling near your leg, you hear it, see it and if you wait too long you’ll feel it. Do you wait for your leg to be eaten ...
The purpose of detention in a hospital under the Mental Health Act 1983, is for treatment. That should not be surprising because that is what hospitals are for. But it is not that simple. Why? What’s being treated? What are the objectives? Mental disorder I start off from ‘mental disorder’ because absent the existence of a mental disorder, there is no point considering treatment. [For the avoidance of arbitrary inferences, the converse of any statement made in this post is ...
