Introduction
Something that is mostly commonly observed in clinical practice is the line between thorough care and excessive prescribing, which is often overlooked. Many healthcare professionals agree that they usually prescribe an additional drug, test, or investigation “just to be on a safer side” While the main purpose behind this is patient protection, however, this raises an important concern: Are we choosing defensive prescribing over rational therapy?
What is defensive prescribing?
Let’s understand what defensive prescribing is. It refers to the use of medications, investigations, or inventions with the main intent of avoiding potential complaints, legal scrutiny, or dissatisfaction, rather than focusing on the clinical indication. Some of the most common examples include:
- Prescribing antibiotics for likely viral infections.
- Adding gastroprotective agents “by default”
- Polypharmacy in stable chronic patients.
- Ordering extensive investigations with low diagnostic yield.
Though the intentions are good, such practices can potentially lead to unnecessary drug exposure, adverse effects, increased healthcare costs, and patient confusion.
Reasons for becoming so common
Various factors are responsible for the rise of defensive prescribing. Some of them are as follows:
- Increasing medico-legal awareness and fear of litigation
- High patient expectations for “active” treatment
- Time constraints that limit detailed counselling
- Pressure to avoid follow-up complaints or dissatisfaction
This is most commonly observed in busy clinical settings, especially in OPDs, where prescribing more is easier than explaining less.
Impact on the patient and the healthcare system
Long-term defensive prescribing can lead to:
- Increased risk of ADRs
- Due to a complex medication regimen, there is a risk of a reduction in medication adherence
- Rise in antimicrobial resistance
- Higher financial burden in patients
From the pharmacy personnel’s perspective, this makes the counselling process more difficult for the patients who don’t know why they are taking multiple medications.
Finding a balanced approach
The goal here is not under-prescribing, but rational, evidence-informed prescribing combined with effective communication, clear counselling, shared decision making, and documentation can often protect the patient without the need for unnecessary multiple medications.
Pharmacists and other healthcare professionals should be encouraged to question, clarify, and counsel, which will eventually help to reduce defensive prescribing practices.
In your clinical experience, what’s your opinion on defensive prescribing? Is it becoming more common, and how can healthcare professionals balance patient safety, legal concerns and rational pharmacotherapy?**
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MBH/PS