This is an interesting one.
As an independent practitioner, if you don't feel that it is right for you
to prescribe a particular drug for a particular patient for clinical
reasons, then you shouldn't prescribe it.
You have to be a little careful what the clinical reason is - the best one
being that you have little experience of a drug which is normally monitored
by consultants.
We have got around the problem in Durham by drawing up a list of named drugs
which are consultant only, and a list which may be shared care with the GP
provided that the consultant provides a set of guidelines. Not unnaturally,
guidelines are a bit slow in coming, it being a bother and all, but it suits
us. If anyone wants the list, I can dig it out at work. The list is part of
shared-care prescribing guidelines, to which all the relevant trusts are
signed up, and it is agreed in a county-wide drug and therapeutics
committee.
In this case, the private vs. NHS bit doesn't count (see my other message).
The problem is that in the patient's eyes, if you refer someone to a
consultant, and then fail to take their advice, then why did you refer them
to that consultant in the first place? A patient asked me that about three
years ago, and I have to admit, it nearly had me stumped. Bearing in mind
that most people like simple logic, and don't realise that all doctors don't
think exactly the same way, I would be really interested to hear if anyone
had a concise answer to this one!
Andrew
Dr. Andrew N. Herd MRCGP
Family Physician
Medical Adviser to Durham Health Authority
Honorary Lecturer in Primary Health Care, Durham University
Editor, Practice Computing
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Jel Coward
> Sent: 13 June 1998 00:45
> Hmm - what if the GP disagrees with the private opinion?
>
> I am still refusing to prescribe tolcapone to a really nice pt of mine
> (all NHS - so apols for mixing me threads) - the consultant is deffo
> miffed and says his local advisory committee (with GPs on it) say that
> GPs can prescribe.
>
> I disagree - esp with two poisonous new drugs recently withdrawn - I
> think with a this new drug then the specialist can carry the can which
> means signing the scripts.
>
> I am well dug in.
>
> Thoughts?
>
> --
> Jelly Bean
>
> 'When you get fed up surfing....
> .....go find some waves'
>
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