Medical students’ attitudes toward inappropriate prescribing behaviors and impairments from alcohol and substance abuse are surprisingly relaxed, reflected in an unwillingness to report their colleagues. A new national study shows that those views are closely connected to students’ own wellness.
Opinions vary according to type of drug
More than one-half of students believe it is acceptable for a physician to write a prescription for an antibiotic to treat a bladder infection in a spouse, and more than one-third think it’s acceptable for a physician to self-prescribe an antibiotic, according to a recent study in Academic Medicine.
Meanwhile, only 8.6 percent of students agree that it’s okay for a physician to prescribe an antidepressant to a spouse, and just 4.9 percent agree that a physician should self-prescribe an antidepressant.
The study examines survey results from 4,402 medical students about their attitudes toward inappropriate prescribing behaviors. Students also were screened for symptoms of burnout and depression based on the Maslach Burnout Inventory.
Study authors compared each data set—students’ survey responses about prescriptions, burnout scores and depression screening levels—to determine how personal distress and mental wellness impact professionalism when it comes to students self-prescribing or reporting substance abuse among their colleagues.
The role of burnout and wellness in professional judgment
Students who demonstrated symptoms of burnout or depression “were significantly more likely to indicate that each of the inappropriate prescribing behaviors was acceptable,” the study authors wrote. “For example, students with burnout had a more than 50 percent increased chance of indicating that self-prescribing antidepressants was acceptable than students without burnout.”
Burnout was associated with participants endorsing three of the four inappropriate prescribing behaviors on the survey, while participants with depression endorsed two of the four inappropriate prescribing behaviors. Similarly, students with burnout were less likely to feel that they needed to support the health and wellness of colleagues or report colleagues’ impairments resulting from alcohol or substance abuse.
“These relationships between burnout and students’ beliefs about appropriate prescribing behaviors and duties regarding impaired colleagues are important because burnout is prevalent not only among medical students but also physicians,” the study authors wrote. “If burnout has a similar effect on these professional attitudes among practicing physicians, burnout may at least partially explain suboptimal physician participation in the process of reporting impaired colleagues and self-prescribing tendencies.”
Reporting impairment: 5 ways medical schools can respond
Survey results also found that a substantial percentage of students don’t feel personally obligated to report impaired judgment or performance among their colleagues.
Although nearly all students—81.7 percent—understand the importance of helping a fellow peer if his or her health is compromised, survey results indicate that they’re less likely to actually report their colleagues’ impairments to authorities. Just 47.5 percent think they should actually report instances of impairment among colleagues tied to mental health, and only a slightly higher proportion of students—58.7 percent—would report a colleague’s impairment from substance or alcohol abuse, according to survey results.
The study authors recommend a few next steps to help medical educators better prepare students for prescribing and monitoring colleagues in practice:
- Start teaching students about prescribing practices early in their medical careers. “Our findings suggests that medical students may benefit from explicit curricula on appropriate prescribing practices,” the study authors note. They add that each course should include lessons on how professional impairment threatens quality care and how to appropriately intervene and support colleagues.
- Medical schools needs to partner with “physician groups, accrediting organizations, academic medical centers and hospitals” to better educate students about appropriate prescribing and the importance of self-regulation. This is especially important for third and fourth-year students who are more likely to support inappropriate prescription practices as they further explore clinical training, according to survey responses.
- Medical educators need to address the hidden curriculum, which “fosters greater reluctance to report colleagues impaired from mental health problems than alcohol or substance abuse.”
- Medical schools should incorporate self-care and wellness into curricula. The low percentage of students willing to report a colleague for self-impairment or seek their own help should they become impaired supports the need for “screening medical students for distress, student wellness programming and innovative curricula focused on self-care,” study authors recommend.
- Conduct more research on self-prescribing among male medical students. Throughout the study, researchers spotted an interesting gender divide: Female medical students were less likely—by about 30-47 percent—to demonstrate “suboptimal attitudes about prescribing and professional responsibility to report” compared to male students.
Tell us: Do you agree with these recommendations? What other solutions should be explored? Share your thoughts in the comments below or on the AMA’s Medical Student Facebook page.
The AMA discourages self-prescribing or prescribing for family members as “professional objectivity may be compromised when an immediate family member or the physician is the patient.” The physician’s personal feelings also may “unduly influence his or her professional medical judgment.” Treating a family member also raises concerns about patient autonomy and informed consent. Review Opinion E-8.19 in the AMA’s Code of Medical Ethics to learn more about ethical policy on self-treatment and treating family.
