A patient left me a message earlier this week: "I was reading the information on the drug that Dr. Rob prescribed, and I am really worried about it." He went on to say he was faxing me the prescribing information, just in case I didn't realize the risk of the medication.

I hate it when people do this. Do they realize that I studied for eight years and have practiced another thirteen? Why would I prescribe something for them that I don't know about? Why would I put my name behind a "dangerous" prescription? Why would they bother coming to me if they thought I did not know these things?

I don't really take it as a personal insult, and I do feel that it is fine to question the doctor. I am sure it has happened that I have given prescriptions with interactions and/or side effects that I did not think of, but there are some levels of questioning that cross the line. I am an internal medicine doctor, so medications are my tool. Would you ask a surgeon, "Are you sure you should make a midline incision? Do you think that a lateral approach may be better?" Do you tell a cardiologist, "I read on the Internet that the non drug-eluting stents are better than the drug-eluting ones"? Do you ask the radiologist, "Don't you think that density could represent pleural plaque rather than an infiltrate?" Probably not.

But somehow, the Internet has made second-guessing medications very easy. Websites have made experts out of everyone who can type. So let me make the following points very clear:

  1. I only prescribe drugs that I feel comfortable prescribing.
  2. I only feel comfortable prescribing drugs that I know the side effects, interactions, and contra-indications of. While there may be very rare side effects I do not consider, this is the exception, not the rule.
  3. My EMR allows me to check interactions, so I do this on every prescription I give.
  4. I do realize the potential danger of drugs, and weigh that out against the potential benefit in each circumstance. The benefit must significantly outweigh the risk for me to prescribe it.
  5. Drugs always have risk. That is why it takes an advanced degree and a license to be able to prescribe them. If they were not risky, then they would be put on the shelf next to peanut butter in the supermarket.

I hate to sound like I don't want to be questioned. I do my best to give each patient enough information that when they walk out of my office, they know why I have ordered each test and prescribed each drug. In that light, perhaps I failed this patient. Maybe I did not give enough information as to the risk/benefits of the drugs.

But then again, I don't get paid for taking more time with my patients. Plus, sometimes more information just increases the worry.

And there are some people who should probably stay away from the Internet.

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