Self-prescribing among medical residents on the decline

The number of medical residents prescribing medications for themselves has declined significantly in the last 14 years, according to a Feb. 27 Archives of Internal Medicine study.

An online survey of 1,267 first-year residents at 16 medical centers found that 8% of prescription drugs taken by interns were self-prescribed, compared with 49% of medications in a 1998 study in The Journal of the American Medical Association.

Researchers didn’t foresee such a stark decline.

“We did anticipate that there would be some differences behind these cohorts, but we were surprised by how dramatic the difference was,” said Constance Guille, MD, Archives lead study author and assistant professor of psychiatry and behavioral sciences at the Medical University of South Carolina in Charleston.

Researchers attribute the decline in part to increased awareness of the pharmaceutical industry’s influence on medical practice. That awareness has led to rules that have significantly reduced drug companies’ presence at academic medical center campuses and made fewer drug samples readily available to residents, the study said.

“Those medications aren’t available, so people are self-prescribing less,” Dr. Guille said.

Eleven percent of residents surveyed said they had taken at least one prescription medication during their internship year. Of 145 medications taken, 50% of prescriptions came from the personal physician and 24% came from a colleague. No intern received a medication from a pharmaceutical representative.

Reasons for self-prescribing

Though the two studies addressed the same topic, differences in the way the anonymous surveys were structured makes them difficult to compare, said David A. Asch, MD, senior author of the 1998 JAMA study and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania in Philadelphia.

The survey for the Archives study was conducted online and done by first-year residents in a variety of specialties. The survey for the JAMA study was administered by mail to internal medicine residents of all years.

Dr. Asch said residents may be more concerned that their privacy could be violated with an online survey versus a paper survey. For example, he said it is surprising that only 47 allergy or asthma medications were reported in the latest study, of which only 2% were self-prescribed. In the 1998 study, residents reported 150 allergy or asthma medications, of which 56% were self-prescribed. “It makes me more concerned about the validity of their results,” Dr. Asch said.

As new physicians, residents work long hours and are given many new responsibilities, including prescribing medications. The combination of their vulnerability and newfound responsibilities makes them more likely to self-prescribe, but such behaviors are rarely witnessed, Dr. Asch said.

“You can imagine that this is a perfect setup to self-prescription,” he said.

Authors of the Archives study said residents responding to their survey reported other potentially sensitive information — such as depression and thoughts of suicide — indicating they had confidence that their privacy was protected.

Dr. Guille said researchers decided to focus only on first-year residents in the latest study because they wanted to avoid recall bias in which second- or third-year residents may have trouble remembering their prescribing habits over longer periods. They chose to expand the survey beyond internal medicine to get a broader picture of residents’ prescribing habits.

“We wanted to see if the phenomenon of self-prescribing extended across multiple specialties,” Dr. Guille said.