By T. Copper. Central Pennsylvania College.
Good practice in the ordering of medicines outlines that residential service providers should ensure sufficient numbers of staff in the residential service have the training and skills to order medicines buy cheap finasteride 5mg on line hair loss cure october 2012. Care should be taken to make sure that only current required prescribed medicines are ordered discount finasteride 1mg with visa hair loss with weight loss, to prevent an overstock cheap finasteride 1 mg amex hair loss cure wikipedia. Medicines delivered to or collected by the residential service should be checked against a record of the order to make sure that all medicines ordered have been prescribed and supplied correctly: The dispensed supply is checked against the ordered medicines order finasteride 5 mg amex hair loss patterns. Prescriptions must take into account the needs and views of the resident, or representatives where appropriate, policies of the residential service, legislative requirements, local and national clinical guidelines, and professional standards. In some situations, registered dental practitioners or registered nurse prescribers may prescribe medicines. All prescriptions should be legible and contain all the information as required by the regulations. As per the Medicinal Products (Prescription and Control of Supply) Regulations, each individual prescription must be in ink, dated and signed by the prescriber in their usual signature. Certain controlled drugs can be prescribed by registered nurse prescribers as laid out in the relevant collaborative practice agreement. In residential services the prescribing and administration of medicines must be documented clearly and must be in line with the relevant legislation. Residential centres should adopt a clear and robust system to ensure that all the relevant information is documented (examples of documents in use include prescription sheets, medicines administration records, medicines prescription and administration record). The prescription sheet should state the resident’s name and address, date of birth, any known allergies to medicines or no known drug allergies, a list of the resident’s medicines, and the prescriber’s name. The medicines administration record should contain the following: a reference to the medicines listed on the prescription sheet the times of administration (which must match the prescription sheet) the signature of the staff member administering the medicine a system for recording, withholding or refusal of medicines and space to record comments. All the details on the prescription and administration records must be clear and legible. A record of allergies or adverse reactions should be maintained on the prescription and administration records. It is recognised that transcribing of any clinical information is a high risk activity and there are serious risks of inadvertent mistakes in transcription, omissions or duplication of medicines. The decision to transcribe a prescription should only be made in the best interests of the resident. An Bord Altranais agus Cnáimhseachais has issued guidance to nurses and midwives in relation to transcription and stated that a nurse or midwife who transcribes is professionally accountable for his or her decision to transcribe and the accuracy of the transcription. It is recognised that some staff who are not nurses will transcribe prescriptions. Local policy must stipulate controls that minimise the risk of error, such as a second member of staff to independently verify the transcribed order. Transcribed orders should be signed and dated by the transcriber, the second member of staff, and co-signed by the prescribing doctor or registered nurse prescriber within a designated timeframe set out in local policy and prior to staff administering medicines. If the transcribed prescription or order is ambiguous or unclear, verification and confirmation must be sought from the prescriber before administering the medicines to the resident. Best practice for the receipt of a verbal or telephone order indicates that, where possible, the medical practitioner repeats the order to a second staff member. A documented record of the verbal or telephone order should be available to staff who administer the medicine. The medical practitioner is responsible for documenting the written order on the prescription sheet within an acceptable timeframe as outlined in local policies and procedures. The use and frequency of verbal, telephone or fax orders should be audited on a regular basis to ensure this process is not misused by prescriber or service to address resident’s needs. Medicines must be stored so that the products: are not damaged by extremes of temperature, light or dampness cannot be stolen do not pose a risk to anyone else are in the appropriate environment as indicated on the label or packaging of the medicine or as advised by the pharmacist. Residential services may provide secure medicine storage for residents in their own rooms. This is essential when the resident looks after and self administers his or her own medicines. If medicines are stored centrally, the cupboards or trolleys must be big 16 Medicines Management Guidance Health Information and Quality Authority enough, well constructed and have a good quality lock. Only medicines and associated documents should be stored in these cupboards or trolleys. Registered providers and persons in charge also need to have specific arrangements in place for the storage of the following, in line with the service they provide: Schedule 2 and 3 controlled drugs nutritional supplements medicines that need refrigeration dressings, ostomy products and catheters medicines supplied in medicines administration compliance aids. In general, kitchens, bathrooms and toilets are not suitable for storing medicines. It is good practice to make sure that nothing else is stored in a medicines cupboard. It is also important that: the keys for the medicine area or cupboard are not part of the master key system where medicines are stored centrally, there is a robust procedure in place for key holding. In some smaller residential settings, storage facilities for medicines may be provided within a kitchen if this is the only available suitable space for storing medicines and measures are taken to ensure medicines are not exposed to excessive heat or humidity. In residential care, there should be a separate, secure fridge that is only used for medicines that require cold storage. A separate fridge may not be necessary in a small centre unless there is a constant need to refrigerate medicines that a resident takes regularly, for example, insulin. If a separate fridge is not used for the storage of medicines, medicines should be kept in a container separate from food. The reliability of the fridge should be monitored through daily temperature checks. In some services, appropriately trained staff other than nurses may administer medicines, for example, in some disability services. It is also important to consult with families and carers regarding the administration of medicines, where it is appropriate to do so. Only prescribed medicines which are in date and are properly stored in accordance with the manufacturer’s instructions should be administered to residents. Residents are advised, as appropriate, about the indication for prescribed medicines and are given access, to the patient information leaflet provided with medicines, accessible health information or pharmacist counseling service. When appropriate, residents should be informed of the possible side effects of prescribed medicines. They should also be afforded the opportunity to consult with the prescriber, pharmacist or other appropriate independent healthcare professional about medicines prescribed as appropriate. Some residents may self-administer medicines, where the risks have been assessed and their competence to self-administer has been confirmed by the multidisciplinary team which includes the pharmacist. Any change to the initial risk assessment is recorded in the care plan and arrangements for self-administering medicines must be kept under review. Medicines administration compliance aids are generally used for suitable oral solid dosage medicines. Medicines administration compliance aids are packed and labelled by a pharmacist and the medicines are taken by, or administered to, the resident directly from the aid. If the prescriber alters any medicine order, the entire medicines administration compliance aid should be returned to the supplying pharmacist for repackaging. All medicines in a medicines administration compliance aid should be identifiable using a tablet identification system in the residential service. Residential services should have policies and procedures for the alteration of oral dose formulations (for example, crushing tablets or opening capsules) to make it easier to administer medicines to residents with swallowing difficulties or enteral feeding tubes. If it is deemed necessary to alter the form of medicines for safe administration to the resident, staff should consult with the prescriber and the pharmacist to discuss alternative preparations or forms of administration for the resident. In some cases, the 20 Medicines Management Guidance Health Information and Quality Authority practice of altering the form of medicines may result in reduced effectiveness, a greater risk of toxicity, or unacceptable presentation to residents in terms of taste or texture. Where medicines are administered in a form change (for example, crushed form, opening capsules, dispersing in water and so on), this may be outside the instructions as provided for in the Summary of Product Characteristics and may be unauthorised. Only medical and dental practitioners can authorise the administration of unauthorised medicines and this should be indicated on the prescription sheet for each individual medicine with the consent of the resident, or his or her representative where appropriate.
Director National Institute on Drug Abuse Principles of Effective 22 Treatment 33 1 cheap finasteride 1mg amex hair loss nioxin. Recovery from drug addiction is a long- and function purchase 5mg finasteride hair loss cure 9090, resulting in changes that persist long after term process and frequently requires multiple episodes of drug use has ceased 5mg finasteride for sale hair loss magnesium. As with other chronic illnesses purchase finasteride 1 mg hair loss cure your cancer, relapses to drug are at risk for relapse even after long periods of abstinence abuse can occur and should signal a need for treatment to and despite the potentially devastating consequences. Because individuals often leave treatment prematurely, programs should include strategies 2. Treatment varies depending on the type of drug and the characteristics of the patients. Behavioral therapies—including Matching treatment settings, interventions, and services individual, family, or group counseling— to an individual’s particular problems and needs is critical are the most commonly used forms of to his or her ultimate success in returning to productive drug abuse treatment. Potential patients can be lost if treatment is not therapy and other peer support programs during and immediately available or readily accessible. For example, needs of the individual, not just his methadone, buprenorphine, and naltrexone (including or her drug abuse. To be effective, treatment a new long-acting formulation) are effective in helping must address the individual’s drug abuse and any individuals addicted to heroin or other opioids stabilize associated medical, psychological, social, vocational, their lives and reduce their illicit drug use. Remaining in treatment for an adequate as patches, gum, lozenges, or nasal spray) or an oral period of time is critical. The appropriate medication (such as bupropion or varenicline) can be duration for an individual depends on the type and degree an effective component of treatment when part of a of the patient’s problems and needs. Treatment does not need to be plan must be assessed continually and voluntary to be effective. Sanctions or modiﬁed as necessary to ensure that enticements from family, employment settings, and/or the it meets his or her changing needs. Drug use during treatment must be patient may require medication, medical services, family monitored continuously, as lapses therapy, parenting instruction, vocational rehabilitation, during treatment do occur. For many patients, a drug use is being monitored can be a powerful incentive continuing care approach provides the best results, with for patients and can help them withstand urges to use the treatment intensity varying according to a person’s drugs. Many drug-addicted individuals also individual’s treatment plan to better meet his or her needs. And when these problems co-occur, as provide targeted risk-reduction treatment should address both (or all), including the use of counseling, linking patients to medications as appropriate. Medically assisted detoxiﬁcation treatment addresses some of the drug-related behaviors is only the ﬁrst stage of addiction that put people at risk of infectious diseases. Targeted treatment and by itself does little to counseling focused on reducing infectious disease risk change long-term drug abuse. Counseling can acute physical symptoms of withdrawal and can, for also help those who are already infected to manage their some, pave the way for effective long-term addiction illness. Frequently Asked 6 Treatment varies depending on the Questions 7 type of drug and the characteristics of the patient. Although some people are successful, many attempts result in failure to achieve long- term abstinence. Research has shown that long-term drug abuse results in changes in the brain that persist long after a person stops using drugs. Long-term drug use results in signiﬁcant changes in brain function that can persist long after the individual stops using drugs. Psychological stress from work, family problems, psychiatric illness, pain associated with medical problems, social cues (such as meeting individuals from one’s drug- using past), or environmental cues (such as encountering streets, objects, or even smells associated with drug abuse) can trigger intense cravings without the individual even being consciously aware of the triggering event. Any one of these factors can hinder attainment of sustained abstinence and make relapse more likely. Services Family Vocational Services Services Drug addiction treatment can include Intake medications, behavioral therapies, or Processing/ Assessment their combination. The best treatment programs provide a combination of therapies Treatments for prescription drug abuse tend to be and other services to meet the needs of the individual patient. Addiction to prescription stimulants, Drug treatment is intended to help addicted individuals which affect the same brain systems as illicit stimulants like stop compulsive drug seeking and use. Treatment can cocaine, can be treated with behavioral therapies, as there occur in a variety of settings, take many different forms, are not yet medications for treating addiction to these and last for different lengths of time. Behavioral therapies can also help people improve There are a variety of evidence-based approaches communication, relationship, and parenting skills, as well to treating addiction. Thus, trained treatment outcomes depend on the extent and nature of counselors should be aware of and monitor for such effects. Relapse rates for addiction resemble Finally, people who are addicted to drugs often suffer from those of other chronic diseases such other health (e. The best programs provide a combination of Like other chronic diseases, addiction can be managed therapies and other services to meet an individual patient’s successfully. Psychoactive medications, such as antidepressants, addiction’s powerful disruptive effects on the brain and anti-anxiety agents, mood stabilizers, and antipsychotic behavior and to regain control of their lives. The chronic medications, may be critical for treatment success when nature of the disease means that relapsing to drug abuse is patients have co-occurring mental disorders such as not only possible but also likely, with symptom recurrence depression, anxiety disorders (including post-traumatic rates similar to those for other well-characterized chronic stress disorder), bipolar disorder, or schizophrenia. Between Drug Addiction and Other Chronic Illnesses”)— that also have both physiological and behavioral components. This is not the case: Successful treatment for than its alternatives, such as incarcerating addicted addiction typically requires continual evaluation and persons. For example, when a patient is $4,700 per patient, whereas 1 full year of imprisonment receiving active treatment for hypertension and symptoms costs approximately $24,000 per person. Drug addiction treatment reduces For the addicted individual, lapses to drug abuse do not drug use and its associated health indicate failure—rather, they signify that treatment needs and social costs. Is drug addiction treatment worth healthcare are included, total savings can exceed costs its cost? Drug greater workplace productivity; and fewer drug-related addiction treatment has been shown to reduce associated accidents, including overdoses and deaths. How long does drug addiction pressure from the criminal justice system, child protection treatment usually last? Within a treatment program, successful clinicians can establish a positive, therapeutic Individuals progress through drug addiction treatment relationship with their patients. The clinician should at various rates, so there is no predetermined length of ensure that a treatment plan is developed cooperatively treatment. However, research has shown unequivocally with the person seeking treatment, that the plan is that good outcomes are contingent on adequate treatment followed, and that treatment expectations are clearly length. Medical, psychiatric, and social services participation for less than 90 days is of limited effectiveness, should also be available. Because some problems (such as serious medical or Good outcomes are contingent on mental illness or criminal involvement) increase the adequate treatment length. After a Treatment dropout is one of the major problems course of intensive treatment, the provider should ensure encountered by treatment programs; therefore, motivational a transition to less intensive continuing care to support techniques that can keep patients engaged will also improve and monitor individuals in their ongoing recovery. By viewing addiction as a chronic disease and offering continuing care and monitoring, programs can succeed, but this will often require multiple episodes of 7. How do we get more substance- treatment and readily readmitting patients that have relapsed. Whether a patient stays in treatment depends on factors associated with both the individual and the program. Individual factors related to engagement and retention Strategies include increasing access to effective treatment, typically include motivation to change drug-using behavior; achieving insurance parity (now in its earliest phase of degree of support from family and friends; and, frequently, implementation), reducing stigma, and raising awareness 16 17 among both patients and healthcare professionals of The Substance Abuse and Mental Health Services the value of addiction treatment.
Dependence A state in which an organism only functions normally in the presence of a substance discount 5mg finasteride amex hair loss cure vitamin d, experiencing physical disturbance when the substance is removed order finasteride 5 mg free shipping hair loss essential oil blend. Drug Diversion A medical and legal concept involving the transfer of any legally prescribed controlled substance from the person for whom it was prescribed to another person for any illicit use finasteride 5 mg lowest price hair loss 40 year old woman. Fidelity The extent to which an intervention is delivered as it was designed and intended to be delivered buy 1mg finasteride overnight delivery hair loss post pregnancy. Gender The social, cultural, or community designations of masculinity or femininity. Health Care System The World Health Organization defnes a health care system as (1) all the activities whose primary purpose is to promote, restore, and/or maintain health, and (2) the people, institutions, and resources, arranged together in accordance with established policies, to improve the health of the population they serve. The health care system is made up of diverse health care organizations ranging from primary care, specialty substance use disorder treatment (including residential and outpatient settings), mental health care, infectious disease clinics, school clinics, community health centers, hospitals, emergency departments, and others. Health Disparities Preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged populations, defned by factors such as race or ethnicity, gender, education or income, disability, geographic location (e. Implementation A specifed set of activities designed to put policies and programs into practice. Impulsivity Inability to resist urges, defcits in delaying gratifcation, and unrefective decision-making. Impulsivity is a tendency to act without foresight or regard for consequences and to prioritize immediate rewards over long-term goals. Inpatient Treatment Intensive, 24-hour-a-day services delivered in a hospital setting. Integrating services for primary care, mental health, and substance use use-related problems together produces the best outcomes and provides the most effective approach for supporting whole-person health and wellness. Negative The process by which removal of a stimulus such as negative feelings or emotions Reinforcement increases the probability of a response like drug taking. Neurobiology The study of the anatomy, function, and diseases of the brain and nervous system. Services may include medically supervised withdrawal and/or maintenance treatment, along with various levels of medical, psychiatric, psychosocial, and other types of supportive care. Pharmacokinetics What the body does to a drug after it has been taken, including how rapidly the drug is absorbed, broken down, and processed by the body. Positive The process by which presentation of a stimulus such as a drug increases the probability Reinforcement of a response like drug taking. Prescription Drug Use of a drug in any way a doctor did not direct an individual to use it. Misuse Prevalence The proportion of a population who have (or had) a specifc characteristic—for example, an illness, condition, behavior, or risk factor— in a given time period. Protective Factors Factors that directly decrease the likelihood of substance use and behavioral health problems or reduce the impact of risk factors on behavioral health problems. Public Health System Defned as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction” and includes state and local public health agencies, public safety agencies, health care providers, human service and charity organizations, recreation and arts-related organizations, economic and philanthropic organizations, education and youth development organizations, and education and youth development organizations. Even individuals with severe and chronic substance use disorders can, with help, overcome their substance use disorder and regain health and social function. When those positive changes and values become part of a voluntarily adopted lifestyle, that is called “being in recovery”. Although abstinence from all substance misuse is a cardinal feature of a recovery lifestyle, it is not the only healthy, pro-social feature. Relapse The return to alcohol or drug use after a signifcant period of abstinence. Remission A medical term meaning that major disease symptoms are eliminated or diminished below a pre-determined, harmful level. Residential Treatment Intensive, 24-hour a day services delivered in settings other than a hospital. Risk Factors Factors that increase the likelihood of beginning substance use, of regular and harmful use, and of other behavioral health problems associated with use. Sex The biological and physiological characteristics that defne human beings as female or male. Standard Drink Based on the 2015-2020 Dietary Guidelines for Americans, a standard drink is defned as 12 f. Substance A psychoactive compound with the potential to cause health and social problems, including substance use disorders (and their most severe manifestation, addiction). Substance Misuse The use of any substance in a manner, situation, amount or frequency that can cause harm to users or to those around them. Substance misuse problems Problems or or consequences may affect the substance user or those around them, and they may be acute Consequences (e. These problems may occur at any age and are more likely to occur with greater frequency of substance misuse. Substance Use A medical illness caused by repeated misuse of a substance or substances. They typically develop gradually over time with repeated misuse, leading to changes in brain circuits governing incentive salience (the ability of substance-associated cues to trigger substance seeking), reward, stress, and executive functions like decision making and self-control. Substance Use A service or set of services that may include medication, counseling, and other supportive Disorder Treatment services designed to enable an individual to reduce or eliminate alcohol and/or other drug use, address associated physical or mental health problems, and restore the patient to maximum functional ability. Telehealth The use of digital technologies such as electronic health records, mobile applications, telemedicine, and web-based tools to support the delivery of health care, health-related education, or other health-related services and functions. Telemedicine Two-way, real-time interactive communication between a patient and a physician or other health care professional at a distant site. Withdrawal A set of symptoms that are experienced when discontinuing use of a substance to which a person has become dependent or addicted, which can include negative emotions such as stress, anxiety, or depression, as well as physical effects such as nausea, vomiting, muscle aches, and cramping, among others. Wrap-Around Services Wrap -around services are non-clinical services that facilitate patient engagement and retention in treatment as well as their ongoing recovery. This can include services to address patient needs related to transportation, employment, childcare, housing, legal and fnancial problems, among others. Government reports, annotated bibliographies, and relevant books and book chapters also were reviewed. From these collective sources, a set of 600 core prevention programs was identifed for possible inclusion in this Report. Evaluation Criteria Programs were included only if they met the program criteria of the Blueprints for Healthy Youth Development listed below. The See Chapter 1 - Introduction and prevention effects described compare the group or Overview. The need for follow-up fndings was considered essential given the frequently observed dissipation of positive posttest results. Level of signifcance and the size of the effects are reported in Appendix B - Evidence-Based Prevention Programs and Policies. Programs that broadly affected other behavioral health problems but did not show reductions in at least one direct measure of substance use were excluded. Centered multiethnic (Grade 8), reduced (2001)11 Intervention schools; 576 risk of starting to use Furr-Holden, et students in other illegal drugs al. Treatment urban French effects on drinking (1996)17 Program Canadian to the point of being (Montreal) students in drunk at age 15. Grade 7 (high- risk subsample), primarily African American and Hispanic Study 2a: N = 758 Study 2a: At 1-year follow- Smith, et al. Health and secondary schools in up (after two years of (2000)26 and Alcohol Harm metropolitan Perth, intervention), reduced (2004)27 Reduction Australia; 2,300 weekly drinking (5%) and Project students aged 12 to harm from alcohol use.
Antidiarrhoeal drugs buy cheap finasteride 5mg line hair loss kelp, such as loperamide and diphenoxylate discount finasteride 1 mg free shipping hair loss in men enhancement, are not indicated buy finasteride 1mg online hair loss yeast, especially for children order 5 mg finasteride with amex hair loss cure jak inhibitor, as they mask the continuing loss of body fluids into the intestines and may give the false impression that ‘something is being done’. Superficial open wound The therapeutic objective in the treatment of an open wound is to promote healing and to prevent infection. The inventory of possible treatments is: Advice and information: Regularly inspect the wound; return in case of wound infection or fever. The wound should be cleaned and dressed, and tetanus prophylaxis should probably be given. All patients with an open wound should be warned about possible signs of infection, and to return immediately if these occur. Local antibiotics are never indicated in wound infections because of their low penetration and the risk of sensibilization. Systemic antibiotics are rarely indicated for prophylactic purposes, except in some defined cases such as intestinal surgery. They will not prevent infection, as permeability into the 38 Chapter 5 P-drug versus P-treatment wound tissue is low, but they can have serious side effects (allergy, diarrhoea) and may cause resistance. Your P-treatment for a superficial open wound is therefore to clean and dress the wound, give antitetanus prophylaxis, and advice on regular wound inspection. Advice, fluids and rehydration are essential in the treatment of acute watery diarrhoea, rather than antidiarrhoeals or antibiotics. Practical examples illustrate how to select, prescribe and monitor the treatment, and how to communicate effectively with your patients. When you have gone through this material you are ready to put into practice what you have learned. It is obvious that making the right diagnosis is a crucial step in starting the correct treatment. Making the right diagnosis is based on integrating many pieces of information: the complaint as described by the patient; a detailed history; physical examination; laboratory tests; X-rays and other investigations. In the next sections on (drug) treatment we shall therefore assume that the diagnosis has been made correctly. Complains of a sore throat but is also very tired and has enlarged lymph nodes in her neck. She is a little shy and has never consulted you before for such a minor complaint. Very sore throat, caused by a severe bacterial infection, despite penicillin prescribed last week. Her problem is completely different from the previous case, as the sore throat is a symptom of underlying disease. Patient 5 (sore throat) You noticed that she was rather shy and remembered that she had never consulted you before for such a minor complaint. You ask her gently what the real trouble is, and after some hesitation she tells you that she is 3 months overdue. Patient 6 (sore throat) In this case, information from the patient’s medical record is essential for a correct understanding of the problem. His sore throat is probably caused by the loperamide he takes for his chronic diarrhoea. Patient 7 (sore throat) A careful history of patient 7, whose bacterial infection persists despite the penicillin, reveals that she stopped taking the drugs after three days because she felt much better. These examples illustrate that one complaint may be related to many different problems: a need for reassurance; a sign of underlying disease; a hidden request for assistance in solving another problem; a side effect of drug treatment; and non-adherence to treatment. He may suffer from a heart condition, from asthma and from his stomach, but he definitely has one other problem: polypharmacy! Think of all the possible side effects and interactions between so many different drugs: hypokalemia by furosemide leading to digoxin intoxication is only one example. Careful analysis and monitoring will reveal whether the patient really needs all these drugs. Isosorbide dinitrate should be changed to sublingual glyceryl trinitrate tablets, only to be used when needed. You can probably stop the furosemide (which is rarely indicated for maintenance treatment), or change it to a milder diuretic such as hydrochloro-thiazide. Salbutamol tablets could be changed to an inhaler, to reduce the side effects associated with continuous use. Cimetidine may have been prescribed for suspected stomach ulcer, whereas the stomach ache was probably caused by the prednisolone, for which the dose can probably be reduced anyway. So you first have to diagnose whether he has an ulcer or not, and if not, stop the cimetidine. And finally, the large quantity of amoxicillin has probably been prescribed as a prevention against respiratory tract infections. However, most micro-organisms in his body will now be resistant to it and it should be stopped. If his respiratory problems become acute, a short course of antibiotics should be sufficient. Box 5: Patient demand A patient may demand a treatment, or even a specific drug, and this can give you a hard time. Some patients are difficult to convince that a disease is self-limiting or may not be willing to put up with even minor physical discomfort. In some cases it may be difficult to stop the treatment because psychological or physical dependence on the drugs has been created. Patient demand for specific drugs occurs most frequently with pain killers, sleeping pills and other psychotropic drugs, antibiotics, nasal decongestants, cough and cold preparations, and eye/ear medicines. The personal characteristics and attitudes of your patients play a very important role. So a prescription is written because the physician thinks that the patient thinks. It may also fulfill the need that something be done, and 46 Chapter 7 Step 2: Specify the therapeutic objective symbolize the care of the physician. It is important to realize that the demand for a drug is much more than a demand for a chemical substance. There are no absolute rules about how to deal with patient demand, with the exception of one: ensure that there is a real dialogue with the patient and give a careful explanation. Never forget that patients are partners in therapy; always take their point of view seriously and discuss the rationale of your treatment choice. Valid arguments are usually convincing, provided they are described in understandable terms. All may be related to different problems: a need for reassurance; a sign of underlying disease; a hidden request for assistance in solving another problem; a side effect of drug treatment; non-adherence to treatment; or (psychological) dependence on drugs. Your definition (your working diagnosis) may differ from how the patient perceives the problem. Exercise: patients 9-12 For each of these patients try to define the therapeutic objective. Sleeplessness during six months, and comes for a refill of diazepam tablets, 5 mg, 1 tablet before sleeping. Consulted you 3 weeks ago, complaining of constant tiredness after delivery of her second child. She has now returned because the tiredness persists and a friend told her that a vitamin injection would do her good. Patient 9 (diarrhoea) In this patient the diarrhoea is probably caused by a viral infection, as it is watery (not slimy or bloody) and there is no fever. She has signs of dehydration (listlessness, little urine and decreased skin turgor).