Relational prescribing encourages practitioners to consider non-pharmacological factors – psychological and relational – in order to improve pharmacological outcomes.
Despite significant technological advances in pharmaceutics, there is general acknowledgement of the limitations and risks of a reductionistic biological model of illness. High-dose prescribing and polypharmacy are usual in psychiatric practice with patients being neither properly informed nor appropriately monitored (Taylor, 2002; POHM-UK, 2012, 2017.) Polypharmacy harms patients and the environment. Medication use accounts for 25% of the NHS’s carbon footprint (NHS England, 2020).
Although psychiatrists incorporate patient centred-care in their work, prescribing is often approached as an algorithmic exercise that overlooks the patient’s psychology. A relational approach is important for all diagnostic groups, but it is particularly needed when treating patients with attachment difficulties and histories of relational trauma.
This module draws from the work of Michael Balint, David Mintz and Psychodynamics of Prescribing (PoP) UK. It summarises the evidence base and suggests a framework to support reflection and teaching of the relational and psychological aspects of psychiatric consultations.
Learning objectives
By the end of this module, you should be able to:
- describe the evidence base for the relational and psychological factors that affect prescribing outcomes
- identify patient-related factors that have an impact on prescribing outcomes
- describe and reflect on clinician-related factors that affect prescribing practices
- recognise what medication might represent in the context of the patient–clinician relationship and adopt a patient-centred approach in prescribing consultations
- take on a clinical leadership role to train and supervise by:
- applying a relational framework to help decision-making with complex prescribing dilemmas in the consulting room and within the wider team
- teaching formulation-informed relational prescribing.
Section headings
- The evidence base
- The patient factor
- The clinician factor
- Patient – clinician relationship
Availability
This module is available as part of a CPD eLearning subscription.
