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• Teaching medical students rational prescribing and improving opportunities for doctors to appraise new treatments enhances rational prescribing
  Joseph Y Ting
  Published on: 18 May 2017

• Published on: 18 May 2017

  Teaching medical students rational prescribing and improving opportunities for doctors to appraise new treatments enhances rational prescribing

  • Joseph Y Ting, Adjunct associate professor

  Greater transparency and regulatory oversight in disclosing gifts and payments to physicians from drug and medical device companies could well reduce their influence on a doctor's prescribing habits and medical management recommendations. The threat of a very public loss of professional reputation among peers and patients is likely to discourage a physician accepting drug and medical device company generosity. However, a m...

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  Greater transparency and regulatory oversight in disclosing gifts and payments to physicians from drug and medical device companies could well reduce their influence on a doctor's prescribing habits and medical management recommendations. The threat of a very public loss of professional reputation among peers and patients is likely to discourage a physician accepting drug and medical device company generosity. However, a more positive, potentially more effective and formative approach would be include in medical school ethics curricula the psychology of gifting and the adverse influence on clinical practice exerted by pharmaceutical company incentives and honoraria. Instead of policing behavior to stop physicians raiding Big Pharma's cookie jar, we should intensively caution our medical students about inappropriate ties with pharmaceutical industry. The latter could form the basis of a career-long ethical approach towards refusing undue gifts and payments.

  Careful scrutiny of drug-company sponsored clinical trials could lead doctors to the conclusion that exciting but expensive new treatments are not superior to reliable old work horses. Sponsored studies may ignore comparisons with long-established effective drugs (there's little income in established patent-expired drugs. By aggressively marketing their newest products, drug companies would have physicians believe otherwise.

  If only doctors had the time at work (preferably paid and without clinical obligation) and the necessary skills to assess the methodological robustness of a study, decipher its findings and apply its conclusions to patients. Such favourable conditions are rarely available outside the journal club, postgraduate training, teaching hospital and medical school.

  If health executives really care about research bearing relevance to patient care in ambulatory and community practice, they need to fund doctors to train in appraising the quality of what they read and pay them for the time spent keeping up to date. Better informed doctors are likely to deliver better care and dividends in improved care will likely outgrow remuneration to doctors.

  Burgeoning health-care evidence needs to be efficiently delivered to doctors caring for patients in digestible allotments that will not prove overwhelming. This involves communicating information relevant to their clinical practice or specialty, in a format and schedule compatible with achieving balance in a doctor's work and personal life.

  Paying doctors for non-clinical time to learn about the latest evidence is a good start. Even if one has not assessed the original studies, investigation and treatment summaries updated with newly emerging clinical research provides a short-hand way for ensuring patients receive the best of care, but requires commensurate time to absorb.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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