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Trying to improve prescribing? Give us a McCall

Trying to improve prescribing? Give us a McCall

When it comes to driving up medication compliance, there is only one real authority, says Dr Tony Copperfield

Have to be honest, I laughed myself moist at the news that better continuity of care is linked with better prescribing for patients at risk of cardiovascular disease. What’s funny about that? Nothing – except the study’s punchline, which showed that while we’re reliably dishing out these pills, these patients reliably aren’t taking them, continuity or not.

Maybe that isn’t so surprising. Patients who value continuity also value not upsetting their regular doctor. Which is why they faithfully collect their scripts but then carefully store them, untouched, in a cupboard, as if proximity to a statin might in some telekinetic, homeopathic way lower their cholesterol.  

What does this tell us, apart from the fact that vast amounts of NHS money are squandered on untaken medicines and unprevented CV events? It tell us exactly the same as another study, which found that large numbers of patients self-inject for B12 ‘deficiency’ and half don’t tell us, presumably because they’re afraid we’ll try to employ things such as logic, rationality and sense.

It all goes to show that we GPs vastly overestimate our influence on our patients’ lives. The punters just go and do their own sweet thing, some having nodded sweetly and dutifully in the consultation and others after nursing a sense of unfulfilled entitlement. Quite right, too.

We’re way less influential than we think when it comes to a patient’s medical trajectory, not least because we see them for just tiny intermittent snapshots of their lives. Those moments might seem important to us, but they’re just blips in the average patient’s rampant autonomy.

Besides, when it comes to authoritative advice on medication and driving up compliance, we know who the real authority is. I wonder if Davina might put a word in for statins?

Dr Copperfield is a GP in Essex. Read more of Copperfield’s blogs here



Please note, only GPs are permitted to add comments to articles

Decorum Est 10 October, 2022 12:57 pm

‘We’re way less influential than we think when it comes to a patient’s medical trajectory’

A medical receptionist informs me that she frequently observes patients that have just come-out of their GPs room, phoning someone and relating what has been said (maybe our role is merely to entertain?)

Patrufini Duffy 10 October, 2022 3:26 pm

Certainly. Well, that’s what one expects for nannying the trivia. Guesswork diffuses, resolved boredom and anxiety forgotten, alongside the reason for the pill plaster and medicalisation of somethings. But, thank goodness for the “triple-lock beneficial holistic patient centered scheme” rolling out next year. Full engagement and empowerment anticipated. Maybe they should add a tick box – is the person willing to engage, or do you anticipate a flop and autonomous floweriness?

Paul Hartley 10 October, 2022 4:10 pm

i once had a patient who complained to me her cupboards were getting full of unwanted medicines. The chemist kept ordering and delivering every month despite her protestations.

Patrufini Duffy 10 October, 2022 7:43 pm

This week a patient booked in because she can’t sleep after she talks to her irritating mum. Another wanted to book in because her landlord walked into the flat unannounced and that is yes, bothering their sleep. Another wanted to tell me there are lots of people ill in Ibiza – they’re all coughing there apparently. Another said she had knee pain after a hike last week but can move her knee absolutely tickety boo fine. Another wanted to talk about her pill (fourth pic’n’mix change now) because ofcourse, that is the cause of her anger outbursts and personality disorder, apparently. Great. Changing the first world.

Patrufini Duffy 10 October, 2022 7:45 pm

Yes Paul, another patient was angry because the pharmacist kept giving them all three gluten free breads from his repeat dispense, instead of one as it was easier to order in. Thus he just binned it.

Malcolm Kendrick 11 October, 2022 8:37 am

Most of the long-term medication we prescribe are of, at best, marginal benefit. Once you have a patient on more than five (which seesm to be almost everyone nowadays) it becomes increasingly likely that they are doing more harm than good [hands up last time anyone saw a doulbe blind controlled stufy on the benefits of adding in a third anti-hypertensive to a patient on two mediation for diabetes a statin and the inevitable PPI – pour example]. Little wonder patients stop taking them. The burden of adverse effects must multiply.

Dave Haddock 12 October, 2022 8:48 am

Have seen a kitchen cupboard with several £thousands worth of unused and mostly expired NHS medication.
Suspect the problem of dispensed but unused medication costs the NHS a huge amount, but would largely vanish if every prescription had a fee attached for every recipient, even if only 50p.
Another consequence of free at the point of abuse.

Paul Hartley 13 October, 2022 9:01 am

I agree with Dave Haddock. Could apply also to the elderly and other exempt groups. There could be a mechanism for reclaiming the fees if they couldn’t afford it, a bit of a bureaucratic hurdle may discourage lazy unnecessary repeat ordering.
Pharmacies make profit from every item they dispense, a bit of a conflict of interest.

Mark Howson 13 October, 2022 6:33 pm

A pharmacy dispensing repeatedly despite patient saying no is defrauding the NHS and you can report to the NHS fraud line.

Paul Hartley 13 October, 2022 7:19 pm

Mark Howson
I reported this practice several years ago to the CCG, but they said if wasn’t their job to Investigate.

Decorum Est 14 October, 2022 12:46 am

The ‘market-place’ would seem to answer many of these issues? But the ‘market-place’ doesn’t’ want to pay anything like ‘market- rates’.

Alice Hodkinson 15 October, 2022 7:11 pm

Just stop prescribing statins unless ppl have had loads of MIs and can’t stop the junk food, can’t stop smoking and can’t get off the couch?
There are some poor souls like that who need statins. Otherwise, let’s prescribe a low carb diet with enough meat to keep them healthy.