Prescription plays a vital role in the practice of medicine irrespective of the system. It gives clear direction to the pharmacists to dispense the medicine and instructs the patients. In the beginning of the practice, there is always a confusion regarding the choice of prescription. Over the years, the system of homeopathy has faced so many changes and challenges. But some aspects of homeopathy have remained unchanged. Among them is the practice of dispensing by the homeopaths themselves refraining from open prescription. However, it is not the case in general. Many well-known physicians and institutes follow open prescriptions with OPD cards and files. Sometimes patients themselves ask for prescription for various purposes. In the current internet era, people take informed decisions due to the availability and accessibility of various sources of information. Consumer authorities have issued guidelines in respect to their rights to know the information on their treatment. Under such circumstances, open prescription merits in so many ways.
My first experience with homeopathy was when I was around 16 years. I visited a homeopath to consult for my cousin. My cousin was given a set of packets to be taken at certain interval for a time period. It really worked very well and he was cured much to our surprise. I was intrigued and got curious as to know what he had taken. Later when I had a chance to meet the doctor I asked him about the medicine. But he was reluctant to reveal the name of the medicine much to my disappointment. Now being a doctor, I feel, it would be unfair if I too did the same. So I started following open prescription. I have received both appreciation and advice for this method of practice. But the practice and patients’ trust only keeps better and better. Same is true for many. This has been a less discussed topic in the professional forums. From the clinical experience and having met and discussed with various peer groups, the positive and negative aspects of transparency as in open prescription are discussed here. Also, guidelines in respect to ethical and legal aspects for starters are given.
Merits of open prescription
- Transparency and trust
When a doctor gives prescription to his patient, it increases the transparency and trust in the doctor-patient relationship. Many patients come and say that they visit this clinic only because they get their prescription on hand. Of course there are patients who Google the remedies we prescribe and they do enquire about the information they have learnt during the next visit. As we clarify they are satisfied. They are hardly less than 1%. Such patients are more obedient in following the instructions and taking their dosages since they also learn that in homeopathy there is no particular medicine for a particular condition.
- To follow-up with other doctors when re-located
This is one of the problems we often face with new patients who were under homeopathic treatment from some other physician. They are unaware of the medicines they have received. If the previous medication is known, it would be better to plan the future course of treatment. Without such details, we have to start afresh. It becomes difficult when the patient who has got relief with the previous medication comes and we are unsure to choose the follow-up remedies.
- Confidence in the system
Giving prescription will definitely improve the confidence in system of homeopathy. It was surprising when a few patients stated that they did not go for homeopathic treatment because of the non-availability of the prescription and subsequent lack of confidence.
- Awareness of homeopathy
In a way, knowing the name and indication of the homeopathic medicines helps to increase the awareness of homeopathy. The best example is West Bengal where most household has a set of homeopathic remedies as a first line of therapy. But they always go for proper homeopathic treatment after that. It doesn’t affect the practice of the homeopaths as it only increases the usage of homeopathy. Because of popularity and familiarity of medicines like Arnica montana, Thujaoccidentalis, Cineraria maritima eye drops, Calcareaphosphorica 6x, many people refer these to their kith and kin.
- Ethics and legality
Medical ethics suggest that it is the duty of the physician to be transparent about the details of the treatment. Department of Consumer Affairs also clearly states about this fact. It is not only just ethical, but can also be a legal risk in case of any undesired effects.
- Growing trend of telemedicine and online platforms
With the emergence of technological advancements, providing consultation to patients of distant regions, country or continent has opened so many opportunities. To grasp such opportunities, being familiar with open prescription is necessary.
- Mediclaim, insurance and medical leave purposes
Many a time patients ask for prescriptions to claim their medical bills and reimbursement as per their respective policies. Increasing workforce of organized sectors has made many employees to fall under the category of one or the other mediclaim and medical reimbursement policies. It requires necessary documents and details of treatments. In such case prescription becomes the foremost document.It is also required to be submitted in case of medical leave application.
- Two way records maintenance
When the records are maintained on both sides from the doctor and the patient, it ensures the easy accessibility of the records. Some times when the doctor is outstation with no accessibility to records, it is easier to suggest SOS medications or follow-up to the patients contacting through phone, emails or messenger apps with their prescription.
So-called demerits of open prescription
- Misuse of medicines
It is one of the frequently argued point when it comes to open prescription. But it doesn’t have much validity. Misuse of medicine can happen even when the prescriptions are not given. Such instances are seldom reported in open prescription.
- Referring placebo
Though mentioning placebo is considered as a difficulty in open prescription, it can be overcome. Many physicians refer to placebo in the prescription with different codes like Sacharumlacticum, Rubrum metallicum, Nihilinum, Phytum, etc. This is no obstacle to give prescription.
- Ensures return of the patient
Whether it is open or obscure prescription, patients always come back if there is desired result or even little improvement. Once a trust is established, receiving patients is not an issue.
- Prevents overdosing
It is a misconceived notion. In fact the opposite is true, since clear instruction on dosage and duration can be given in open prescription.
- Prevents self-medication
Though it is partially true, the incidences are very less. Statements like “Please do not self-medicate” printed in the prescription and mentioning the date of next review will in itself prevent such instances.
Essentials for an ideal prescription
An attractive file folder with name of the clinic and doctor, qualifications, timings, contact number, website/blog, if visiting in different places then the addresses with days and timings, etc. will be smarter idea. Cost of such folders with printing starts even from Rs. 10/-. To compensate this expense, first time consultation charge may be kept little high. A folder will also help to keep the diet guides, laboratory reports, etc. A prescription sheet should contain the required details and instructions for the patients.[1]
Do’s and Don’ts for Doctors in respect to medical ethics and consumer affairs[2]
Some of the points mentioned in the Journal Indian Academy of Forensic Medicine are worth mentioning. Relevant points to homeopathy are summarized below:
Do’s for Doctors:
Mention your qualifications/ training/ experience/ designation on the prescription. Always mention date and timing of the consultation. Mention age and sex of the patient. In a pediatric prescription weight of the patient must also be mentioned. Always put your hand on the part that the patient/ attendant say is painful. Apply your stethoscope on him, even if for cosmetic reasons. Listen attentively. Look carefully, ask questions intelligently. Always face the patient. Do not stare, especially female patients. Ask the patient to come back for review on the next day, if you are not sure about the diagnosis/treatment. Mention “diagnosis under review” until the diagnosis is finally settled. In complicated cases record precisely history ofillness and substantial physical findings about the patient on your prescription.Record history of drug allergy.Write names of drugs clearly. Use correct dosages. Always advise the patient not to stop taking a drug suddenly which is required to be tapered before it is stopped. Remember major drug interactions like anti-dotes and inimical. Mention where the patient should contact in case of your non-availability/ emergency. If you are not sure of the diagnosis, get an expert opinion. Whenever referring a patient, provide him with a referring note.Participate in at least one national / international conference every year. Update your knowledge and skill from time to time. Update not only your own knowledge and skill, but also that of your staff. Update the facilities and equipment according to prevailing current standards in your area. Preferably employ qualified assistants. If not available, impart proper training and skill at your clinic. Routinely advice X-rays in injury to bones and jointsand related diseases of bones/ joints. Always rule out pregnancy before subjecting theuterus to X-ray.
Don’ts for Doctors:
Don’t prescribe without examining the patient, even if he is a close friend or relative. Never examine a female patient without presence of female nurse/ attendant, especially during genital and breast examinations. Don’t smoke while examining a patient. Don’t examine a patient when you are sick, exhausted, or under influence of alcohol or any intoxicated substance. Don’t be overconfident. Don’t look overconfident. Don’t over-prescribe/ administer too much of the drug, too large a dose, for too long. Never talk loose of your colleagues, despite intense professional enemy. Don’t do anything beyond your level of competence. Competence is defined by your qualification, training and experience. When you are not sure what and why to do, consult your senior/ specialist/ colleague.Don’t refuse the patient’s right to know about the hospital rules, regulations and hospital charges. Don’t refuse if the patient/ attendants want to leave against medical advice (LAMA). It is their right. Document this properly. Never avoid a call for help from a nurse on duty at night. A genuine emergency may be there. Never label any condition as “functional” until you are as certain as possible of the accuracy. Don’t leave at the moment of death. There is a tendency especially on the part of senior doctors to go away at this time when his presence and experience are most needed. Don’t hesitate to extend your condolences and sympathies to the bereaved persons. Don’t issue death certificates unless you have yourself verified it. Don’t divulge secrets you come to know during discharge of your professional duties. Don’t deny medical care to a patient with HIV infection/ AIDS. Observe all necessary precautions. Don’t inform that the person is infected with HIV unless confirmatory test results are received. Don’t give untrue, misleading or improper reports, documents, etc. Do not leave a patient unattended during labor.
[1] Dr. R. Valavan, Setting up an ideal homeopathy clinic, Homeopathy For All, Vol. 15 No. 06 (174) June 15 2014
[2] Prakash C, Roy Chaudhary SK, Bala R, Shrivastav B, Rai A, Roham. Consumer Protection Act (CPA/COPRA) Related to Medical Profession. JIAFM, 2007; 29(3) : 39-41.