Last month, the Tennessee Department of Health sent out letters contacting the top 50 prescribers in the state–which includes physicians as well as nurse practitioners and physician assistants–to request that these individuals justify their higher than average prescribing. While simply prescribing more than one’s peers does not de facto mean that a provider is practicing outside the standard of care, oftentimes these top prescribers raise numerous red flags in the Department of Health’s audit. This review process–which ultimately may lead to discipline for many healthcare providers across the state–raises the question: why do healthcare providers overprescribe? As with most complex issues facing the healthcare profession, the answer isn’t simple.
Healthcare Providers Overprescribe Because We Expect Them To.
We live in a culture where we as patients expect to receive a prescription when we go to a healthcare provider’s office for treatment. This expectation is systemic of a broader cultural problem where we as consumers seek an easy fix for our problems. In turn, these cultural expectations make it difficult for a healthcare provider to go against a patient’s presumptions by choosing not to write a prescription. For example, a provider may be more inclined to write a prescription for opioids when a patient complains of lower back pain rather than addressing the underlying issues, such as the patient’s weight and lifestyle choices. Healthcare providers–just like most of us–would prefer to avoid conflict, and often must walk a delicate balancing act between sound healthcare advice and perceived judgment when issues like weight and substance abuse need to be discussed.
Additionally, many patients get upset, or feel like they “aren’t getting their money’s worth” if the patient pays for an office visit and leaves the provider’s office without a prescription. Such a perception requires a cultural shift in the expectation of what physician’s role in a patient’s health should be. While a prescription may solve a problem in the short-term, long-term solutions to chronic health problems require active participation by the patient, not just prescription writing by a provider.
Healthcare Providers Overprescribe Because They Don’t Realize They Are Doing It.
Without proper documentation, it may be difficult for a healthcare provider to even realize that he or she is overprescribing. Accurate documentation tells a story, and this story should document the provider’s medical decision making in determining when to start, stop, increase, or decrease a prescription. Providers who take the time to justify their prescription writing via documentation may quickly realize that the medication he or she intends to prescribe to a patient isn’t, in fact, justifiable. By documenting properly, by reviewing notes from prior visits with patients, providers can avoid falling into the trap of simply prescribing something because it was prescribed it to a patient previously.
We need to empower our healthcare providers to treat both with and without a prescription pad, but to most importantly treat patients with their own expertise and based on their own documentation–without overwhelming expectation from patients to leave a provider’s office with a prescription in hand every time.