Safe prescribing

Kaveh Shojania proposes several solutions to the pitfalls associated with illegible or hard-to-interpret prescriptions, including 2 suggestions of ways to prevent misinterpretation of written prescriptions.1 The first and best, according to the author, is to have physicians indicate both the generic and the brand names of a medication on the prescription, with the example “Zyrtec (cetirizine)” mentioned for illustration. Although this idea may appear logical and foolproof, it might lead to the dispensing of more expensive medications, since, on reading the prescription, the pharmacist may interpret it to mean that only the branded version of the product should be used.

The second proposed solution is to write the indication along with the product (as in “Zyrtec for rash”), but this approach, too, has drawbacks. What would the author have written if prescribing Zyprexa (olanzapine) for the dishevelled person described in case 1? I also wonder if the legal and ethical aspects of this suggestion have been reasonably examined. These concerns arise from my experience as a former pharmacist and a practising psychiatrist. With this background, I recognize that although physicians may take for granted the confidentiality of data on their prescribing habits (as collected by IMS and sold to pharmaceutical companies),2^,3 this may not be the case. At present, disclosing too much information without adequate safeguards has the potential to create problems not easily anticipated by prescribing physicians.

Finally, the author suggests that electronic prescribing will prevent medication errors. I agree that it may aid in this arena, although the safeguards against legal and ethical issues are far from clear. Wouldn't it be a shame to see e-prescribing evolve into mass marketing, whereby prescribers are bombarded by email messages from competing pharmaceutical companies for each product that they prescribe?