A prescription for better prescribing

摘要

No-one knows the origin of the well-known prescription sign (Figure 1), but an attractive hypothesis is that it is derived from the utchat, or Eye of Horus, the symbol of good fortune and healing used by the ancient Egyptians and others (Figure 1) . The sign of the utchat was worn by Egyptians to give them the strength of the sun and to maintain their good health, and it was inscribed in documents to ensure their success. When we inscribe its modem equivalent on a prescription we symbolically give the prescription the seal of success. But are our prescriptions always successful? Unsuccessful prescribing takes several forms: under-prescribing, overprescribing, inappropriate prescribing, irrational prescribing, and prescribing errors. Underprescribing is perhaps the most common of these, and we are again reminded of it in this issue of the Journal. In one of a series of four thorough reviews of various drug treatments in elderly patients, Mangoni and Jackson remind us that only a proportion of elderly patients with stable heart failure receive ACE inhibitors, despite good evidence of efficacy, and that those who are treated often receive inappropriately low doses . In another of their articles they suggest that elderly patients should be given a statin regardless of their serum LDL cholesterol concentrations ; but we have previously published evidence that although prescribing of statins is increasing they are still being under-prescribed