Why should a medical provider not prescribe medication to a patient they have not evaluated or assessed?

Why Medical Providers Should Not Prescribe Medications Without Patient Evaluation

Medical providers should never prescribe medications to patients they have not personally evaluated or assessed, as this practice compromises patient safety, violates professional standards, and increases liability risks. 1

Patient Safety Concerns

• Prescribing without proper evaluation prevents accurate medication history collection, which is essential for identifying potential drug interactions, allergies, and contraindications 1
• An accurate medication history is critical for preventing prescribing errors, with studies showing that 67% of medication histories contain at least one prescription error, 22% of which have potential for significant patient harm 1
• Lack of proper assessment prevents identification of patient-specific risk factors that could lead to adverse drug reactions or treatment failure 1
• Without evaluation, providers cannot determine appropriate dosing based on patient characteristics such as age, weight, renal function, and comorbidities 1

Professional Standards and Guidelines

• Medical practice standards require that providers have a clear understanding of the patient's condition before initiating any treatment, including medication therapy 1
• The American College of Cardiology/American Heart Association performance measures emphasize evidence-based practice that requires proper patient assessment before prescribing 1
• Professional guidelines mandate that prescribers take responsibility for determining whether medication use is absolutely or conditionally indicated based on scientific evidence or prior treatment response 1
• Proper documentation of medication indication and ongoing review of medication appropriateness are considered best practices that require direct patient evaluation 1

Medication Error Prevention

• Taking an accurate medication history requires specific information from the patient, including details of all prescription medications, over-the-counter drugs, herbal remedies, and alternative treatments 1
• Drug allergies and previous intolerances must be accurately documented through direct patient questioning about the dose, reaction suffered, and temporal relationship to the drug 1
• Physical examination is necessary to look for effects of drugs and to guide appropriate laboratory investigations 1
• Assessment of medication adherence requires direct patient interaction and cannot be properly determined without evaluation 1, 2

Legal and Ethical Considerations

• Prescribing without evaluation may constitute patient abandonment or substandard care 1
• Documentation of patient assessment is legally required; the principle that "what is not written does not exist" applies to medication prescribing 3
• Proper assessment includes checking prescription drug monitoring programs (PDMPs) for concurrent controlled medications prescribed by other clinicians 1
• Urine drug testing, which requires direct patient contact, is recommended before starting certain medications like opioids 1

Risk Mitigation Strategies

• Direct patient evaluation allows for proper education about medication risks, benefits, and proper administration 1
• Patient identity should be verified using at least two patient identifiers at the time of prescribing and dispensing 1
• The most recent clinical information should be reviewed to validate treatment plans, including diagnosis, allergies, and correct drug dosing 1
• Potential drug interactions must be actively reviewed at each patient encounter through conversation with the patient about recent medication changes 1

Special Considerations

• For patients with psychiatric conditions requiring involuntary treatment, direct evaluation is still necessary to determine capacity and appropriateness of medication 4
• Even in emergency situations, some form of assessment is required before medication administration 4
• Telehealth may provide an alternative to in-person evaluation in some circumstances, but still requires direct patient assessment 1

By following a systematic approach to prescribing that includes proper patient evaluation, providers can minimize poor-quality and erroneous prescribing while ensuring patient safety 5, 6.