Prescribing Medication

Introduction

Medical professionals who prescribe medications must have the authority to do so. Each medical professional, doctor, or surgeon will have a different focus regarding the patient's medication needs. A doctor's specialty or area of expertise will greatly influence the types of medications that he or she prescribes the patient.

 

Who Can Prescribe Medications?

For a healthcare professional to be able to prescribe medications, he or she must be licensed and have prescriptive authority. We'll now look at some of these professionals.

Family practice physicians, or general practitioners, are the traditional family doctors who treat patients of all ages for a wide array of medical problems. Family practice physicians are often the first healthcare professionals that patients turn to for treatment, advice, and referrals to specialists. Family practice physicians often treat acute conditions like upper respiratory infections and the common cold virus, as well as common chronic conditions like asthma and COPD (chronic obstructive pulmonary disease).

Allergists are doctors who specialize in the diagnosis and treatment of allergic reactions. One of the most common allergic reactions is hay fever. Antihistamines are commonly ordered for the treatment of allergies. For some patients, an allergy can be so severe that it can be life-threatening. This type of allergic reaction is called an anaphylactic allergic reaction. Bee stings, in addition to shellfish, peanuts, and other foods, are common triggers for anaphylaxis. Patients with such allergies need an allergy plan and need to be trained on the use of an epinephrine autoinjector like the EpiPen or Auvi-Q.

Dermatologists are doctors who diagnose and treat diseases of the skin. A dermatologist undergoes three to four years of specialty training after medical school. At the end of the specialty training, the individual must pass an oral and a written exam for certification. Major skin disorders requiring drug therapy from a dermatologist include certain types of skin infections and skin inflammation.

Ophthalmologists are doctors who specialize in diagnosing and treating diseases of the eye. An eye doctor usually completes three years of specialized training after graduation from medical school, plus one year of active practice. Applicants must then take an examination for certification as ophthalmologists. Ophthalmologists may prescribe medications used to treat glaucoma, eye infections, and inflammation.

 

Rheumatologists are doctors who diagnose and treat diseases of the joints, muscles, and bones. Rheumatologists commonly treat arthritis, certain autoimmune diseases like lupus and fibromyalgia, and rheumatoid arthritis. They may also treat tendonitis, gout, and osteoporosis. 

Unfortunately, there's no absolute cure for arthritis, so doctors of rheumatology prescribe drugs to treat the symptoms of pain and inflammation. Reducing inflammation in the joints is very important to delay permanent damage to the joints, and relieving pain is essential to allow patients to participate in their usual activities of daily living. Rheumatologists rely on both anti-inflammatory and analgesic medications for treating common forms of arthritis. Patients with rheumatoid arthritis may be ordered on immunomodulators or disease-modifying antirheumatic drugs (DMARDs) to help slow the progression of the disease. Some medications used to treat rheumatoid arthritis are intravenous infusions that are administered in the physician's office by a registered nurse.

Urologists treat diseases of the urinary tract, which includes the kidneys, the ureters, and the urethra. Urology is also a surgical specialty. The American Board of Urology requires a minimum of five years of postgraduate medical training and practicing in a community for 16 months. After that, the candidate may sit for the written and oral exam to become certified. 

Urologists treat both men and women for kidney and bladder stones, cancers of the urinary system, conditions related to infertility, and any other diseases or infections of the urinary system. Urologists often prescribe urinary antiseptics and antibiotics. 

Endocrinologists are doctors who diagnose and treat disorders of the endocrine system. These disorders are known as glandular diseases because the endocrine system is composed of different glands that secrete hormones. For example, diabetic patients may follow up and see an endocrinologist for management of their blood sugars.

While obstetricians focus on childbirth, gynecologists focus on the care of medical and surgical conditions that apply only to female patients. A gynecologist often practices obstetrics too. Such a doctor is called an OB/GYN. 

The American Board of Obstetrics and Gynecology requires the completion of four years of postgraduate residency training. After residency, a physician may seek certification through the American Board of Obstetrics and Gynecology. The candidate must pass a written and oral examination to become certified.

One common drug classification prescribed by OB/GYNs is oral contraceptives. They're usually ordered as a form of contraception, but they may also be prescribed to treat several other health conditions.

Gastroenterologists are doctors who specialize in the treatment of disorders of the gastrointestinal tract, which includes the esophagus, stomach, intestines, and lower bowel. Common conditions that a gastroenterologist may treat are gastroesophageal reflux (heartburn) and peptic ulcers.

 

Orthopedic physicians deal with injuries and disorders of the musculoskeletal system. Therefore, the orthopedic physician is often called on to perform bone surgery. Orthopedic doctors treat bone fractures. Some bone fractures require surgery to set the bone so that it will heal correctly. These physicians also perform joint replacement surgery for the treatment of severe degenerative joint disease.

Pain is always involved when bone fractures occur. Pain is also a normal component of the postoperative period after orthopedic surgery. These physicians often prescribe medications used to relieve pain.

General surgeons are physicians who specialize in the surgical treatment of the abdominal organs, including the intestines, esophagus, stomach, colon, liver, and gallbladder. The general surgeon is a highly trained physician who deals with diseases and injuries that require some sort of surgical treatment. Many general surgeons receive further training to specialize as cardiac surgeons, vascular surgeons, plastic surgeons, neurosurgeons, and other similar specialties. Many of the medications prescribed are for pain and antibiotics to treat infection.

The American Board of Surgery requires five years of specialized surgical residency training before an applicant can be examined for general surgery certification by the board. 

Geriatricians are physicians who specialize in healthcare for older patients, generally defined as people who are over the age of 65 years. Geriatricians commonly deal with heart problems and other cardiovascular disorders, arthritic disease, diabetes, thyroid disorders, problems with hearing and eyesight, insomnia, nutritional disorders, and neurological and memory disorders.

Geriatricians specialize in treating the multiple disease problems that older patients often encounter and can develop special care plans that address the healthcare needs of the patient. These physicians prescribe a variety of different medications to treat many different conditions. It's important to note that geriatric patients often have increased sensitivity to medications and may need lower doses of some prescribed drugs.

Hospitalists are physicians who specialize in the care of patients in hospitals. These physicians generally work only in hospitals and see patients on a daily basis while they're in the hospital for treatment. On-site hospitalists can sometimes provide more effective care for hospitalized patients than primary care physicians, who would need to travel from their private offices to the hospital to check on their patients. Hospitalists prescribe a wide variety of medications needed to treat patients while they're hospitalized.

Neurologists are doctors who treat disorders of the brain and the central nervous system. Neurologists don't perform surgery, but they're responsible for the care of patients with brain vascular disease, migraine headaches, epilepsy, multiple sclerosis, muscular dystrophy, and brain and spinal cord tumors. Neurologists commonly treat seizures and headaches. These physicians prescribe anti-seizure medications, medications for migraines, and sometimes muscle relaxants or antianxiety agents.

The American Board of Psychiatry and Neurology certifies neurologists and psychiatrists. There are two pathways of study that may be used to meet the training requirements for certification. Depending on the pathway used, the board requires four to six years of residency and postgraduate training. The candidate must apply to the board and pass an examination prior to certification.

 

Psychiatry is the branch of medicine that deals with the origin, prevention, diagnosis, and treatment of mental and emotional disorders. Psychiatrists are licensed doctors of medicine. The American Board of Psychiatry and Neurology requires that a candidate complete three years of specialized residency training and postgraduate training prior to being eligible to sit for the examination for certification.

Psychiatrists often prescribe medication for a variety of mental health conditions such as anxiety, depression, attention deficit disorders, bipolar disorder, and schizophrenia.

 

Pediatricians specialize in treating children from birth through puberty. A pediatrician focuses on nutrition, mental and physical growth, immunization against infectious disease, and the management of acute and chronic illnesses. Pediatricians often prescribe antibiotics because of the many ear and throat infections diagnosed in children.

The American Board of Pediatrics requires medical school graduates to complete three years of graduate pediatric training, followed by two years of pediatric practice. The candidate must also pass written and oral examinations.

Cardiologists are doctors who treat diseases of the heart. Some of the major diseases of the heart that are treatable with drugs are congestive heart failure, arrhythmia, angina, arteriosclerosis. Cardiologists often prescribe medications like anti-hypertensives for high blood pressure, anticoagulants to thin the blood, antiarrhythmics to help the heart rhythm, and diuretic medications to help get rid of extra fluid in the body.

 

A variety of doctors who work in the dental field can prescribe medication based on the needs of their patients. Some specialists will prescribe medications more than others, but all have the ability based on the needs of their patient.

Orthodontists and prosthodontists are two different dental specialties that do occasionally prescribe medications. Orthodontists specialize in the diagnosis of malocclusion and the correction of tooth misalignments by the repositioning of the crooked teeth with braces and other appliances. An orthodontist will occasionally prescribe medications that reduce saliva formation in order to be better able to place orthodontic appliances on the teeth.

Prosthodontists specialize in making and fitting dentures for patients who have lost some or all of their teeth. A prosthodontist may occasionally prescribe a cream or ointment to treat gum irritation caused by ill-fitting dentures.

Periodontists are dental specialists who study and treat gum disease. Periodontists diagnose the causes of gum disease and treat the disease with improvement in oral hygiene, drug therapy, and surgery. Periodontists prescribe many types of antibiotics to treat gum disease and analgesics to reduce pain after periodontal surgery.

Endodontists are dentists who treat disorders of the tooth pulp, which is located inside the tooth and extends into the canals inside the root of the tooth. These canals carry the nerves and the blood supply that provides the tooth with nutrients. If the tooth pulp canal becomes infected with bacteria, the outcome is severe inflammation and pain that results in a toothache. Instead of removing the tooth, the endodontist saves the tooth by performing a root canal. The endodontist prescribes antibiotics and anti-inflammatories. 

General-practice dentists provide dental care ranging from tooth cleaning to restorative procedures on teeth, simple extractions, simple root canal procedures, and simple orthodontic treatments. These dentists may prescribe many medications, including analgesics, antibiotics, sedatives, and anti-inflammatories.

Pediatric dentists provide dental care to children and adolescents. They very rarely prescribe medications. Occasionally, fluoride preparations are prescribed for children who live in areas without fluoridated water.

Oral medicine/oral pathology specialists treat diseases of the head, neck, and soft tissues of the oral cavity. They work with patients to diagnose and treat oral and jaw pain, as well as bacterial infections, fungal infections, and viral infections. These specialists also diagnose and treat head and neck cancer. They can prescribe medications from many of the drug classifications, including analgesics, antibiotics, antifungals, and antiviral agents.

 

Podiatrists specialize in treating medical problems of the feet. Doctors of podiatry graduate from schools of podiatric medicine that offer a four-year curriculum after graduation from a four-year baccalaureate college. Podiatry focuses on the examination, diagnosis, treatment, and prevention of diseases affecting the foot. Disorders of the foot include foot pain, circulatory disorders, nerve disorders, skin and toenail disorders, tumors and cysts, arthritic and inflammatory disorders, and trauma.

Podiatrists write prescriptions for medications to treat foot disorders. Common drug classifications that podiatrists may prescribe are analgesics, antibiotics, anti-inflammatories, topical preparations, and foot soaks.

Nurse practitioners are able to provide a broad range of health services and care to patients, including obtaining a patient's history; performing a physical exam; and ordering lab work, tests, and procedures. Nurse practitioners are able to diagnose, treat, and manage diseases. They have the authority to write prescriptions (some states do have restrictions on the extent of prescriptive authority) and perform some procedures. There are variations in prescribing laws among the states. Variations include the independent authority to prescribe, restrictions on prescribing, dealing with controlled substances, and the necessity to collaborate with the physician. Nurse practitioners may order medications from a wide range of drug classifications, depending on the patient's condition.

Most nurse practitioners have a master's degree and several years of nursing experience. Nurse practitioners are licensed in the state where they practice, and most of them are certified. National certification is available, and some states require certification for the nurse practitioner to practice. With the implementation of the Affordable Care Act, the scope of practice and prescriptive authority is expected to continue to broaden.

Physician assistants are members of the healthcare team who work with and under the supervision of physicians. They're permitted to obtain patients' medical histories, perform comprehensive physical exams, order diagnostic testing, and perform routine medical procedures. They may also develop health management plans for patients. In most states, physician assistants may write prescriptions.

 

Key Points

• Healthcare professionals must be licensed and have prescriptive authority to be able to prescribe medications.
• General practice doctors or hospitalists treat and prescribe medicine to patients for a wide variety of disorders, symptoms, and diseases.
• Specialists prescribe medications based on the specific needs of their patients and their own areas of expertise. Surgeons will generally prescribe medications for infection and pain for patients.
• Dentists, both general and in specialty areas, will prescribe medications to patients based on their medical needs pertaining to dental work and oral health.
• Nurse practitioners and physician assistants are medical professionals who can prescribe medications for patients while they work with a doctor for the patient's care.