Should Doctors Place More Emphasis on Prescription Medication Instructions?

My wife has a nose for news. She found the story in the tweet above about an Iowa driver who ran over a mailbox while she was allegedly under the influence of prescription medication. While we don’t know what the medication was, there are a great many drugs which have the potential for causing impaired driving skills, including but not limited to alertness, reaction time, hand-eye coordination, and judgment.

The list of drugs is not limited just to psychiatric agents. Opioids, muscle relaxants, antihistamines and others can lead to impaired driving skills as well as sedating anti-anxiety and antidepressant medications, mood stabilizers, antipsychotics, and sleepers.

It can make patients wonder whether physicians leave all the responsibility of drug education and warnings up to the pharmacists. The news story carries the implication that perhaps doctors aren’t doing their part in discussing the potential side effects of the drugs they prescribe.

I think it’s unlikely that most physicians don’t discuss the risks and benefits of the medications they prescribe to their patients. In my opinion the vast majority of practitioners don’t expect patients to read the package inserts and leave it at that.

And communication between doctors and patients is a two-way street. Patients need to feel empowered to ask questions about the medications their doctors prescribe.

Another facet of this issue are the fairly strict regulatory restrictions on obtaining a pilot’s license if one is taking psychoactive medications. The requirements for obtaining the right to fly an airplane can include neuropsychological testing as well as a full psychiatric evaluation, even if a psychotropic drug an applicant is taking is not being prescribed by a psychiatrist. This happens more often than some might think because primary care physicians actually prescribe about 80% of antidepressants.

When you consider that there may be well over 200 million licensed motor vehicle drivers over 18 years of age in the U.S. alone (estimate from here) the problem of the potential for driver impairment from prescription drugs could be substantial.

On the other hand, should doctors be in charge of restricting the driving privileges of their patients based on whether or not they’re taking prescriptions drugs? Are there certain classes of drugs which possibly carry more risk (benzodiazepines for example) which deserve more attention and stronger cautions? Does the number of drugs a patient takes influence the issue? Should it matter how long patients have been taking the drugs prescribed, taking into account the development of tolerance for certain side effects of some medications? It gets pretty complicated in a hurry.

What are your thoughts?

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Comments

  1. Good points. In my view discussing side effects and potential complications of medications are the single most important part of a physician’s job. After the diagnosis is made, the selection of the medication is generally not a problem, but that is often where the interaction ends. There are a lot of people who leave the office and either do not pick up the prescription or pick up the prescription and do not take a single pill based on whether or not the risk/benefit discussion has been sincere or not. I know because I have been that patient.

    The common newspaper portrayal of psychiatric practice being simplified into prescribing misses the point that prescribing medications in a serious manner is not easy. It takes time. I have had the occasion to read 150 pages and study a medication problem all weekend long to make sure the decision was a good one. I have also found that handouts are not enough. When you have written thousands of prescriptions and followed those patients that information is more valuable to pass along than data from a clinical trial listed in a package insert. The information also needs to be tailored to an individual’s medical history, their family history, and special concerns about medication. All of that needs to happen before the informed consent discussion where alternate therapies need to be discussed. All of this can take at least 30-50% of the time in any clinical encounter depending on the complexity of the situation.

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