Editor, – Dr Joanne Hayes' letter to the Pharmaceutical Benefits Advisory Committee ('Your questions to the PBAC' Aust Prescr 1998;21:19) concerned a patient under psychiatric care who needed increased quantities of benzodiazepines. I have a similar patient.
I thought the response from the PBAC was inadequate because it did not solve Dr Hayes' problem. Are they saying we will turn a blind eye to your illegal back dating or forward dating of prescriptions in this situation?
There must be a better solution than the PBAC response. I would not have thought there would be an enormous number of patients, under the care of a psychiatrist, requiring 50 mg of diazepam a day on a long-term basis in Australia.
I would have thought a reasonable compromise situation might be that patients, under the care of a psychiatrist, requiring diazepamin a dose greater than 25 mg daily should be able to have an appropriate authority prescription.
Larry Light
General Practitioner
Altona, Vic.
Editor, – Dr Hayes' letter ('Your questions to the PBAC' Aust Prescr 1998;21:19) raises several points that the reply from the PBAC did not acknowledge.
- Although no doubt Dr Hayes' patient benefits greatly from her presence, and the talk that a general practitioner visit generates(the 'soft end' of good medicine that non-clinicians seldom, and the bean-counters never, understand), on the face of it, Dr Hayes is acting as a deliverer of scripts for a drug ordered by someone else. Not only could this be seen as a somewhat demeaning role, but she may be exposed, at the psychiatrist's behest, to charges of over-servicing and inappropriate prescribing.
- If the PBAC cannot see its way to making special arrangements with general practitioners for such a case, at least it could make one with specialists. It would then fall to the specialist to explain the necessity for the unusual dosage, and the general practitioner's prescribing pattern would not be distorted on the pharmaceutical watchdogs' dossier. It would also release the general practitioner to make visits required by clinical, not bureaucratic, necessity.
- Much benzodiazepine use, according to the PBAC, was 'inappropriate'. On page 4 of the same issue, the prescribing of cerebral vasodilators is called 'undesirable'. Who is the judge of these things? Specialists in the relevant fields seem quite happy to prescribe both. Is an old person, with something lacking in his brain so that his nights are hellish and sleepless, more undesirably 'dependent' on a sleeping pill (oxazepam is the present favourite)than a diabetic dependent upon insulin? If I ever get to that stage (and cannot afford a draught of vintage, cooled a long age in the deep-delved earth), I hope my general practitioner will have the compassion to do a bit of 'inappropriate' prescribing.
Alasdair Livingston
Surgeon
Mitcham, S.A.
