"Can you prescribe me a pick-me-up?"
With post-COVID-19 fatigue prevalent in many of us, doctors may be faced with patients asking for vitamins or tonics to help alleviate their symptoms. Dr Rachel Birch, Medicolegal Consultant at Medical Protection, addresses this common query.
Mrs B, a 38-year-old teacher and mother of two, attends Dr D to discuss her tiredness. She tells him that she feels exhausted most of the time and wonders if he can prescribe her a tonic or some suitable vitamins to help her feel better. She has already had a range of blood tests, which have all come back normal.
Mrs B does not have any other relevant physical symptoms and Dr D has excluded a mental health cause for her fatigue. He tells her he cannot prescribe vitamins and Mrs B asks him to recommend a suitable preparation that she could purchase. Dr D does not feel he has sufficient training in the use of vitamins and explains this to Mrs B. She becomes distressed and threatens to make a complaint to the Medical Council.
Dr D telephones Medical Protection to discuss his concerns further.
Advice
Whenever a patient asks for something to help with tiredness, it is important that doctors have taken a full history and undertaken an appropriate examination and investigations, such as blood tests, so that they have excluded a treatable cause for the patient’s symptoms. Tiredness may be a symptom of many illnesses, and it would be helpful to explore the patient’s concerns, particularly if they appear distressed. Mrs B may have a particular worry, such as cancer or long COVID, or perhaps she is struggling with her work-life balance. Good communication is the core of general practice and perhaps Mrs B’s request for vitamins, as well as her dissatisfaction that Dr D cannot provide her with a simple fix, are symptoms of how she is feeling in general.
Doctors may find it helpful to refer to Medical Council guidance in circumstances where they may feel uncomfortable about a patient’s request.1 The Medical Council advises doctors to recognise and work within the limits of their competence. It is important to make sure that any treatment, medication or therapy prescribed for a patient is safe, evidence-based and in the patient’s best interests. Doctors should weigh up the potential benefits with the risks of adverse effects and interactions when prescribing medication. The guidance also highlights that doctors should review patient’s treatment regimes periodically and may wish to liaise with a pharmacist if there are any issues or concerns.
Dr D may wish to reassure Mrs B that he understands her concerns, and it may be helpful to talk through her blood results with her, so that she has an appreciation of what causes for her tiredness have been excluded. Since she has asked for a vitamin supplement, she may be particularly interested in the results of any vitamin levels, such as Vitamin D, Vitamin B12, Folate and Iron. Consistent with Medical Council guidance, it would be important to provide Mrs B with sufficient information, in a way that she can understand, to enable her to exercise her right to make informed decisions about her care.
In the spirit of open communication, Dr D may wish to explain to Mrs B why he feels there is nothing suitable he can prescribe for her tiredness, as well any reason why he feels recommending a specific vitamin preparation is outwith his area of expertise. However, it may be helpful to signpost Mrs B to the local pharmacist for further advice. Since it is important for doctors to be aware of over-the-counter medication patients are taking, he may wish to suggest that Mrs B lets him know what the pharmacist recommends.
Dr D should fully document his discussion with Mrs B in her medical records. Hopefully, by his demonstrating understanding and empathy, Mrs B will decide not to pursue a complaint to the Medical Council. However, if she does, Dr D may request further assistance from Medical Protection.
1Medical Council - Guide to Professional Conduct and Ethics for Registered Medical Professionals