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Inappropriate prescribing



It's been a while since I posted but I had to share frustration! This week I saw a new patient who has been receiving prescriptions for Librium and Serax (benzodiazepine) from her dentist/oral doctor. That was only one of a long list of issues this woman had which were concerning to me. But when there's a trickle, there's a flood. I also just received notice of a new referral for a woman needing geriatrics care whose ophthalmologist has been filling her ativan.

These specialists may very well be well-meaning, trying to help these women's anxiety in the face of either poor or lack of primary care. But the unintended consequences of such prescribing is frightful to think of.

It raises for me the profile of:

  1. The lack of knowledge most practicing providers have on inappropriate medications for older adults
  2. The likelihood that there are probably countless more patients who are receiving prescriptions for medications which not only should not be prescribed to them but should be given and monitored by a primary care physician or psychiatrist and not by a specialist
  3. How many providers who, even if they know such prescriptions are beyond their scope of practice, may prescribe such drugs because: it's easier, it quiets their patient, or it's harder to say no or to tell the patient to get it from their PCP/psychiatrist or to find a PCP/psychiatrist

by: Helen Kao

Comments

Thanks for sharing. I'm also very concerned about how many older adults get prescribed the wrong medications/doses. Seems like most physicians and other prescribers aren't aware of the serious side effects that can result from what they thought was a trivial refill. Yet these scripts can literally mean the difference between life and death for some patients.

There is an article called "Promoting More Conservative Prescribing" http://jama.ama-assn.org/content/301/8/865.full that I like to use when teaching med students and physician colleagues. It is easy to read, full of common sense clinical pearls, and applies to prescribing for patients of all ages.

Wen Dombrowski, MD
Fredrick said…
Hey Implante, why you are silent here?? I found this informative just.

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