Euan Lawson has once again caught the moment with his thoughts and observations.1 Tackling polypharmacy through deprescribing is certainly to be applauded. As a young partner in the late 1980s I remember being responsible for a small care home. Over a year I worked hard at convincing the patients that they did not need all the drugs they were on. It was a battle and there was some success initially. Over time, through need and the intervention of others, most ended back on the very drugs that had been stopped. This should not stop one from trying though. It still remains a joy to my ears to hear a patient say, ‘Do I really need all these drugs, doctor?’
Ivan Illich should be mandatory reading for all healthcare professionals. It was recommended to me during my training and though out of date in parts has many lessons wrapped up inside it. I have often given a copy as a parting gift to trainee GPs along with William Pickles’ biography.
The expansion of social prescribing to include exercise and wellbeing etc. sadly reflects on a society that cannot provide guidance and support through the family or community unit but must have a ‘specialist’ input.
We encourage expectation of prescription through our very language. ‘What may I do for you?’ is a common opening line. I am now trying ‘What is troubling you?’ or even ‘Now then’. In the hope that it is understood I will listen but may not necessarily prescribe.
- © British Journal of General Practice 2020
