Philadelphia, PA -- A new study from researchers at the University of Pennsylvania Medical Center shows that the common practice of self-prescription by physicians begins at the outset of one's medical career. Indeed, the practice of self-prescription is evidenced during residency training -- the in-hospital, specialty-training period that occurs after graduation from medical school. According to the study, more than half, or 52%, of the residents surveyed reported that they prescribed medications for themselves. In addition, 42% of self-prescribed medications were obtained from a hospital's "sample closet," with another 11% being obtained directly from pharmaceutical company representatives. The study appears in tomorrow's Journal of the American Medical Association.
"We know from previous studies that self-prescription is common among practicing physicians. Now we know the practice starts early," says David A. Asch, MD, MBA, senior author of the study and also Executive Director of Penn's Leonard Davis Institute of Health Economics. To examine residents' behaviors, Asch and his colleagues surveyed 316 residents enrolled in four different internal-medicine residency programs in the United States (specifically, Johns Hopkins University, Stanford University, Tulane University, and the University of Pennsylvania).
Although self-prescription appears the norm among both residents and practicing physicians, there are some troubling aspects associated with such activity. Foremost among those is that professional objectivity is lost when physicians self-prescribe. "A physician who treats himself has a fool for a patient," cautions Jason D. Christie, MD, lead author of the study and a pulmonary fellow at Penn. "This may not be a problem when self-treating for minor or self- limited conditions. But a loss of objectivity means also that one can lose sight of when the line has been crossed." According to the study, the classes of drugs most frequently self-prescribed were antibiotics, allergy medications, and contraceptives. Only two percent of residents indicated personal use and/or self-prescription of psychotropic drugs (used typically to treat depression, anxiety, and sleep disturbances).
The source of the self-prescribed drugs represents still another area of concern, adds Christie. "If pharmaceutical companies are offering these drugs to ingratiate themselves with physicians who will then be more likely to prescribe their drugs to patients, then we have created a conflict-of-interest that potentially puts physicians ahead of their patients. We should view this the same way we view all gifts from drug companies to physicians," he concludes.
Finally, Asch and his colleagues urge a concerted educational campaign be undertaken by the medical profession (and especially residency program directors) to counsel new physicians about the problems inherent in self-prescribing medications. "If organized medicine's view of self- prescription is that it is a bad thing because it represents a loss of objectivity, and yet studies reveal that the practice is rampant, then we either need to change our policy view or do something to reduce the practice.
"One of the characteristics of a profession is that it looks within itself to identify ways for self-improvement," continues Asch. "We either need to decide that self-prescription isn't so bad, or we need to put self-prescription on the professional agenda. This is particularly true for resident physicians. Perhaps the best opportunity for encouraging life-long physician behavior begins with physicians-in-training. To that end, residency program directors should put the issue of self-prescription out into the open, so that it can be discussed explicitly, rather than merely winked at."
Editor's Note: David A. Asch, MD, MBA, can be reached directly at (215) 898-5611.
Journal
JAMA