Question

In addition to ME/CFS I have developed both arthritis and osteoporosis and now require drug treatment for these two conditions. I was recently prescribed a new and fairly powerful drug that soon exacerbated a number of my ME/ CFS symptoms. However, I received no warning that this was something that could happen. As a result, the drug had to be stopped and changed to another one that I was able to tolerate. This upset might have been avoided if my doctor had also considered the potential side-effects a bit more carefully, and discussed them with me, before writing the prescription. Why doesn’t this happen?

Answer

Every drug that a doctor prescribes has the potential to do harm. The General Medical Council (GMC) has issued very clear advice to doctors on safe prescribing. This guidance is aimed at reducing both prescribing errors and problems with side-effects. And one crucial part of this guidance is to talk to patients about the drug that is going to be prescribed. Before deciding whether to prescribe any medicine, the GMC’s prescribing guidance says that doctors must make a proper assessment of the patient’s condition.

This should include taking an adequate history, including any allergies and adverse reactions that a patient has experienced, taking note of existing medical conditions, and the use of other medications. Doctors should also encourage patients to be open about their use of any illegal drugs (which could include the use of cannabis for pain relief) and alternative remedies, and their adherence to previous drug therapies.

Under the principle of ‘informed consent’ the GMC states that any proposed treatment should be agreed with the patient who should be informed about:

• the likely benefits and risks, including serious and common side-effects.
• what to do in the event of a side effect or worsening of symptoms.
• how and when to take the medicine and how to adjust the dose if necessary, or how to use a medical device.
• the likely duration of treatment – arrangements for monitoring, follow up and review, including further consultation, blood tests or other investigations, processes for adjusting the type or dose of medicine, and for issuing repeat prescriptions.

This ‘safety net’ advice should help patients (and their carers) feel in control and increase the likelihood that problems will be picked up quickly. Patients should also be given the chance to ask questions and doctors are told to consider providing information leaflets or signposting them to the pharmacist for additional support. This is all very sensible advice – I only wish it was being followed more widely.

See also: 

• • The 2021 NICE Guideline ME/CFS: Drug Treatments.
  • Treatments: Drug Sensitivities and Side Effects.
  • Treatments: Prescribed Drugs and Informed Consent.
  • Treatments: Prescribed Drugs and Weight Gain.

More information

• The General Medical Council: Good practice in prescribing and managing medicines and devices | April 2021 (updated March 2022)