Overprescribing by doctors

Borg

I am wondering how prevalent overprescribing by doctors is today and whether others have experienced this as well. In order to stay within the guidelines, I'm not discussing specifics of any illnesses, drugs or treatments.

My wife had a recent experience where a general practitioner suggested putting her on a medication. The doctor didn't even bother to tell her that she would have been stuck on it for the rest of her life. We also learned that medication probably would have had side effects that would have also needed treatment. The lifetime mix of drugs would have seriously degraded her health and her life expectancy. During a follow-up with a specialist, he stated that there was absolutely no reason to put her on any medication and that she is fine.

This is not the first time that we have experienced this and it's not just one doctor. It seems that the first response by doctors is not to analyze the problem (if there even is one) but to just prescribe the latest fad drug. With close calls like this, we are very averse to accepting any course of treatment without researching it ourselves first. To be fair, I think that this particular situation could also be a result of the way that my wife approaches her health concerns. She asks for non-standard tests as part of her yearly physical, researches any outlier values and questions the doctors about the results. However, this doesn't explain every incident that we've personally seen.

What is the incidence of overprescribing by doctors today? Is this due to drug companies advertising their products so much that the doctors believe that drugs are a cure-all for everything? Or, is it possibly some other reason such as laziness or plain ignorance?

hypatia

I believe it always is a good idea, to take a active part in your medical care. This would include interviewing a prospective Doctor, and asking for references.

Making your point of view known, is also a good idea. My doctors know I will research just about everything, including new and old methods of treatment. I feel free to talk {and disagree} with them about anything.

That being said, I am also pretty sure that your wife and I, are the exceptions. Many people accept what their medical provider does, without question, after all they are the professionals. Things like internet access, income, and location must also play a part in a persons ability to research medical ailments.

It would really be hard to discover how many prescriptions are unnecessary, except to bring up personal antidotes.

TubbaBlubba

I can't comment on your wife and the situation of related diseases since you don't mention any specifics. But if the doctor put a healthy person on medicine with adverse side effects, what the hell was he, some kind of witch doctor?

Regardless, I have experience with this in several ways. My father has been a anesthesiologist and clinical physician for over 30 years, and my mother is severely impaired with rheumatoid arthritis and has been on heavy medication for about 20 years. Furthermore I have a tissue disease myself as well as psychiatric problems. So I might be able to provide some insight. It might also be worth mentioning that I'm from Sweden.

When it comes to antidepressants, for a first thing, I think that there's a very large overprescription of largely uneffective treatments - That is SSRI (sertralin, ciproxil, etc). Anecdotally I've only ever experienced a slight anxiety dampening effect from them. On the other hand, bieffects are rare and mild, and apparently many people get better from them. From my own experiences, SNRI and antihistamines are somewhat more effective. Then there's also the sedating drugs - Mainly benzodiazepines. They used to be prescribed so much here around the West Coat of Sweden it was referred to as the "Valium coast". People went on huge treatments for years and years for anxiety and generally ended up more impaired by the medication than their anxiety. I believe it's better now, however. But in general the psychiatry in Sweden is in a very sad state, and psychiatrists are largely underavailable. Hell, it took me four years to get one that could recognize me as bipolar and try lithium treatment (fingers crossed, still setting it up).

Pain medication is another story. From my experiences, there's something of an overconfidence in NSAIDs (Aspirin, diclophenac, ibuprofen...) combined with paracetamol, even for quite severe chronic pain, and an underavailability of (re)habilitative gymnasicts. On the other hand, the alternative would be opiates (or "semi-opiates" like Codein), and those carry their own bag of problems, addiction and sedation being the most obvious.

What's more... Well, antibiotics is a well-known issue; People use it far too much. I've heard of it being a problem largely in latin America and Asia, but I don't know much more about it.

But what one needs to recognize in the end is that physicians are people. There are good and bad physicians. Some are too adverse to medicines, some are too reliant on them, et cetera. A good physician, in my opinion, recognizes the risks, compares them to the benefits, and is willing to try something out to see if it works. Somewhat truistic, perhaps, none the less true.

I wouldn't put it to something as simply as ignorance or doctors believing drugs curing everything, however. Most phyisicans are aware of the mechanisms of the drugs they prescribe (if the mechanisms are known); what they help for, what they don't help for, and so on. It's more of a risk-reward-alternative thing.

Borg

Good morning, hypatia and TubbaBlubba! Thanks for responding.

She makes her point of view known but I think that she gets the GPs out of their comfort zone. After that they seem to run home to mama (the prescription pad).
She's definitely an exception and I've learned a lot from her. I used to think that she was being paranoid about physicians but, now I don't think so. Doing the research yourself is a pain but the alternative could be worse.
I wasn't sure if there were studies on this.
I'm not saying that prescriptions are always bad.
I definitely agree. I can't remember the number of times physicians have tried to prescribe it to us for viruses. Even after you ask them why they would prescribe antibiotics for a virus when it would have no effect, they still want to prescribe it.

mgb_phys

Because people don't feel that their doctor is taking them seriously unless they get a prescription.
It's especially bad with older people in places with social medicine (at least in the UK/Canada) - they grew up as the first generation that could get free prescriptions and consider it a basic right.

Knowing this, smart GPs used to prescribe vitamin C tablets (but with a latin name) as basically a placebo - then this was banned.
So the cheapest/easiest drug to prescribe was Paracetamol(Acetaminophen) which is unfortunately a rather nasty overdose risk.

The result was everybody over 60 having bottles of 100s of these tablets (generally out of date and not stored properly) in their bathroom.
Ironic when you can't buy more than 16 at a time in the drug store.


I once worked for a startup doing personal genome sequencing - the whole personalized medicine thing.
One doctor we talked to laughed off the whole idea, according to him GPs only needed to know how to prescribe three things:

Paracetmol = there's nothing wrong with you, go away
Valium = who's got time to listen to your problems.
Antibiotics = you're ill but I don't know what it is, it will get better in a week on it's own.

TubbaBlubba

Paracetamol is a very, very potent painkiller... When used in combination with other drugs. For example, you usually get paracetamol and morphine before a surgery, and paracetamol + NSAID of choice is a standard painkilling cocktail. Overdosing is, as you say, quite easy, though - 20-25 pills will turn your liver into swiss cheese.

I seriously don't get what kind of working morale a physician who would prescribe antibiotics to someone just to calm them down would have. I really don't. And even then you should only prescribe it in cases that aren't getting better or which might lead to severe complications (inner ear inflammation, for instance, should always be treated with antibiotics since it can lead to meningitis).

I really haven't had the perception that physicians just casually prescribe drugs even when they aren't needed - On the other hand I haven't had much contact with GP:s since my father is one (well, technically he's an anaesthesiologist but he's been taking extrajobs as a GP all the time forever). I know I've heard stories about doctors who had ridiculous amounts of patients - like ten in an hour (that includes exam, journal updating, etc), when getting paid by case, but I don't think this is very common; On the other hand I can see that a lot of people get tired by the fact that many people go to the ER just because they are lonely and have nothing better to do... at 3 AM.