Informed consent
The law says that you have the right to make an informed decision about which treatment to have, and whether or not to accept the treatment a doctor suggests. To consent, properly, you need to have enough information to understand the nature, likely effects and risks of the treatment, including its chance of success, and any alternatives to it. Generally, you can only receive treatment that you have specifically agreed to. Once you have given your consent, it isn’t final and you can always change your mind. This consent to treatment is fundamental, and treatment given without it can amount to assault and negligence. To find out more about when treatment can be given without consent, read our blog post on ‘Consent to Medical Treatment’.)
Patient Information Leaflets
If you are prescribed medication as an outpatient, or from your GP, you should find with it an information sheet called a patient information leaflet (PIL), in accordance with a European Union directive. As an inpatient, you may have to ask for it, specifically.
The EU directive sets out what information should be included in the leaflet, and in what order. The order in which the information is given has recently changed, to make it more ‘user-friendly’. Many PILs will still follow the old pattern until they are revised, but the information they include should be the same:
- both the trade and general (generic) names
- the strength of the medicine and the form it takes; for example, each tablet contains 5mg of drug X
- who it is intended for; for example, adults, children, babies
- the type of medicine it is; for example, a tricyclic antidepressant
- what it is licensed to treat; for example, depression
- things you need to know before taking it, such as conditions which mean you should either not take it at all, or you should take it with caution
- the instructions for taking it: whether by mouth or other route; at what time of day; when to take it in relation to meals (if necessary)
- a list of possible side effects, with an indication of how likely they are to occur
- the expiry date of the drugs and how to store them
- a full list of all the ingredients, including the extra contents that hold it together as a tablet or capsule, such as maize starch, gelatin, cellulose, and colourings. This information is important because some people may be allergic to one or other of the ingredients, such as lactose or gluten or a colouring.
- The final item on the leaflet tells you that it contains only the most important information you need to know about the medicine, and that if you need to know more, you should ask your doctor or your pharmacist.
There is a lot of information to include in the PIL, so it’s often printed in very small type, on a piece of paper that is folded many times, which may get thrown away with the packaging, by mistake. If you do not receive this information with your medicine, you should ask for it from the person who makes up your prescription.
Some of the information is quite hard to understand, and the Commission on Human Medicines has been looking at ways of making it easier. They have produced a leaflet Taking medicines – some questions and answers about side effects which you can find on their website or request by telephone. There is more information on medicines and their use, in the form of Medicines Guides, available from the Medicines Information Project website.
You should also consider talking to a Pharmacist. Pharmacists are drug specialists and may be more knowledgeable about your drugs than the doctor who prescribes them. They may be more aware of possible side effects, and also possible interactions with other drugs (this is when a drug changes the effect of other drugs you are taking, makes them less effective, or causes additional side effects). Pharmacists are usually very willing to discuss drugs with patients, and some high-street chemists have space set aside where you can talk privately.
Medicines Use Review
People who regularly take more than one prescription medicine, or take medicines for a long-term illness, are encouraged to go to Pharmacists who are operating the Medicines Use Review (MUR) scheme for a full discussion of their medicines and any problems they may have with them. The Medicines and Healthcare products Regulatory Agency (MHRA), who are responsible for overseeing the licensing of medicines, have produced a guide to the scheme.
Many people would like to have the information about their proposed treatment before they are given the prescription for it, and not after they have got it from the pharmacist and taken it home. The following are issues you might like to discuss with your doctor when she or he gives you a prescription for a drug:
- What is the name of the drug, and what is it for?
- How often do I have to take it?
- How long will I have to take it for?
- If I am taking any other drugs, will it be all right to take them together?
- Will I still be able to drive?
- What are the most likely side effects, and what should I do if I get them?
- Do I have to take it at any particular time of day? For example, if it is likely to make me sleepy, can I take it at night rather than in the morning? If it is likely to make me feel sick, can I take it with or after food?
- When I want to stop taking it, am I likely to have any problems with withdrawal?
- You may well think of other questions you wish to ask.
If you have troublesome side effects, or withdrawal symptoms when you stop taking your medication, you can report them yourself to the MHRA on their website or their hotline. You don’t need to go through a health professional to do this, although you can if you wish. You can also see a full list of side effects reported on the same website.