title: Principles of conservative prescribing.
abstract: Judicious prescribing is a prerequisite for safe and appropriate medication use. Based on evidence and lessons from recent studies demonstrating problems with widely prescribed medications, we offer a series of principles as a prescription for more cautious and conservative prescribing. These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer nonurgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients' reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).
authors.affiliation: Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA. gschiff@partners.org
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: William L
authors.initials: WL
authors.lastname: Galanter
authors.forename: Jay
authors.initials: J
authors.lastname: Duhig
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lodolce
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Koronkowski
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Lambert
mesh_terms: D011307:Drug Prescriptions; D006801:Humans; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'