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:
- I only prescribe drugs that I feel comfortable prescribing.
- 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.
- My EMR allows me to check interactions, so I do this on every prescription I give.
- 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.
- 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.