An in-depth analysis of rational prescribing practices among medical interns and the gap between knowledge and real-world application.
You've felt it before—that wave of relief when a doctor hands you a prescription. It's a tangible solution, a promise of healing. But have you ever wondered what goes through a young doctor's mind as they write their very first prescription? For medical interns, fresh out of the classroom and thrust into the high-stakes hospital environment, this is a monumental moment. Are they equipped to make the best, most rational choice for their patient?
Rational Prescribing is the cornerstone of effective and safe healthcare. It means selecting the right medicine, for the right patient, at the right dose, for the right duration—all while considering cost and potential side effects. When prescribing goes awry, the consequences can be severe: from mild side effects and wasted money to antibiotic resistance and serious patient harm . A recent study sought to pull back the curtain on this critical skill by assessing the prescribing habits of our future doctors: the interns .
Before we dive into the study, let's break down what "rational prescribing" actually means. It's more than just matching a drug to a disease. Think of it as a doctor's mental checklist:
Sometimes, the best treatment is lifestyle advice, reassurance, or simple monitoring.
For most common conditions, medical guidelines recommend a specific, proven, and cost-effective first-line treatment.
The doctor must consider the patient's age, weight, allergies, other health conditions, and other medications to avoid dangerous interactions.
Too little is ineffective; too much is dangerous. Finishing a full course of antibiotics is crucial to prevent resistance.
The World Health Organization (WHO) has even developed core prescribing indicators to measure these practices in the real world, tracking metrics like the average number of drugs per prescription or the percentage of antibiotics prescribed .
To understand how well these principles are being applied, researchers designed a straightforward but powerful observational study. Let's take an in-depth look.
To assess the knowledge, attitude, and current prescribing practices of medical interns in a busy hospital setting.
A detailed, anonymous questionnaire administered to medical interns to capture their real-world thought processes.
The study was conducted with a clear, step-by-step approach:
A group of willing medical interns, all in their first year of hands-on training after graduation, was invited to participate.
Each intern was given a detailed, anonymous questionnaire. This wasn't a pop quiz, but a tool to capture their real-world thought processes.
The collected questionnaires were analyzed to find patterns, strengths, and concerning gaps in their prescribing behavior.
The results painted a nuanced picture of an intern's journey toward becoming a rational prescriber.
Most interns had a decent theoretical grasp of rational prescribing principles, scoring around 70% on average on the knowledge section.
While over 90% of interns agreed that rational prescribing is crucial, their actual prescriptions told a different story.
The average number of drugs per prescription was 3.2, exceeding the WHO recommended limit of 2.0.
"This study is crucial because it identifies the precise pressure points in medical education. It shows that simply teaching the principles is not enough."
While interns showed a fair theoretical understanding, areas like managing side effects and selecting from an essential medicines list showed room for improvement.
| Prescribing Indicator | Study Finding | WHO Recommended Standard | Status |
|---|---|---|---|
| Average Drugs per Prescription | 3.2 | < 2.0 | Exceeds |
| Prescriptions with an Antibiotic | 65% | 20-30% | Exceeds |
| Prescriptions with an Injection | 15% | 10-15% | Borderline |
| % Drugs from Essential Medicines List | 55% | 100% | Below |
The practice data reveals significant deviations from ideal standards, particularly concerning polypharmacy and antibiotic overuse.
| Influencing Factor | % of Interns Reporting "Strong Influence" |
|---|---|
| Treatment Guidelines / Formulary | 45% |
| Advice from Senior Doctors | 88% |
| Fear of Patient Complications | 72% |
| Patient/Parent Demand for Medication | 58% |
| Promotions from Pharmaceutical Companies | 31% |
The influence of senior doctors and fear of complications were the most powerful external factors, overshadowing formal guidelines in many cases.
In a study like this, the "reagents" aren't chemicals, but the methodological tools used to capture complex human behavior.
The backbone of the study. It standardizes data collection, allowing researchers to compare responses across all interns systematically.
A psychometric scale used to quantify attitudes and subjective opinions, turning feelings into analyzable data.
Short, realistic patient scenarios that simulate real-life decision-making without risking actual patient safety.
A validated set of metrics that provide a universal "ruler" to measure prescribing quality against international benchmarks.
The journey of a medical intern is one of the most challenging transitions in any profession. This study shines a light on a critical part of that journey: the moment they pick up the prescription pad. It reveals that our future doctors have the right intentions but are often navigating a complex system that can push them toward irrational habits.
The takeaway is clear and hopeful. By identifying these gaps, we can move beyond just hoping our doctors "figure it out." We can design targeted interventions—better mentorship, protected teaching time, and reflective practice sessions—to ensure that a doctor's first prescription is not just an act of hope, but a well-informed, rational decision for every patient's well-being. The prescription, it turns out, is not just for the patient, but for the continuous improvement of the healthcare system itself.