A licensed physician, unlike other restricted professional groups, has the ability to prescribe all medications (except for a few with special restrictions such as specific specialist competency requirements). The background to this is, according to our interpretation, the assumption that the physician has a special competence to evaluate drugs in relation to other therapies and the overall health of the patient.
Responsibility – basic conditions
Under their own professional responsibility, a licensed physician generally has the opportunity to take responsibility for situations where his own knowledge is insufficient and therefore a patient should be referred or a colleague consulted. This responsibility also means that the physician has the right to question and change prescriptions from other physicians and other professional groups.
A possible starting point for a discussion of the roles and responsibilities of prescribers is the insights that can be expected from patients. A reasonable assumption is that the patient is assuming that the physician who last prescribed the medication – introduced, changed the dose, extended or discontinued treatment – did so based on the patient’s entire picture of the patient’s disease and all medications. It is also reasonable to assume that the patient in most cases does not assume that the physician has automatically assumed responsibility for the control and evaluation of all other medications.
Different roles and responsibilities of a doctor
If we start with the presumed picture of the patient and the fact that drugs are only one form of treatment out of several, the otherwise complicated question of a physician’s responsibility can be easily framed on three points:
- The physician who is providing care for the patient is responsible for the continuation of the treatment prescribed by that physician, but also for the interaction of these and other treatments for the patient.
- This physician is responsible for assessing whether or not previously prescribed treatment by other physicians is appropriate for the patient’s overall health and ongoing treatment.
However, the doctor did not automatically take responsibility for the continuation of all other treatments the patient has. This responsibility rests with the doctors who prescribed the last therapy in accordance with the first paragraph.
Another way of expressing this is that one and the same doctor in meeting with patients has different roles on the one hand for individual drugs depending on whether the doctor has prescribed them or not, and on the other hand for the entire treatment. Different roles also mean different responsibilities in each role.
Regardless of what happened during the patient-doctor meeting, and regardless of whether the doctor who meets the patient prescribed something or not, that doctor always has a responsibility to the patient to give him the support he needs when needed. to carry out previously prescribed treatments.
This responsibility may, if the matter is not urgent, be borne by the physician by contacting the patient with a physician previously prescribed by him. However, the responsibility of the attending physician for drug addiction treatment cannot be diminished without consulting a physician absent from the patient-physician meeting, e.g. a physician who is particularly responsible for the patient in the patient’s clinic.
The medical profession must have a coordinated view of the professional roles and responsibility for individual prescriptions and for the overall treatment of the patient.
This applies to all types of therapies – not only drugs – and how they interact with each other, but also how a patient’s health may affect them. The need is particularly obvious for a patient’s medication list, whether documented in a consistent healthcare patient record or in a future national comprehensive medication list as an integral part of the patient record.
It is important that the National Board of Health and Welfare explains how responsibility for a patient’s drug list should be interpreted, inter alia because other occupational groups than physicians also prescribe drugs. This can be done in the form of a revised regulation or through a guide to an existing regulation.
At the same time, the National Council for Health and Welfare should explain how it perceives the concept of prescription, especially in the event of a change in treatment duration or responsibility for follow-up examinations. The starting point for this work should be the role model and responsibilities in prescribing drugs – presented here by the Swedish Medical Association and pharmaceutical committees.