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Why the Pharmacology Principle of Administering A Minimum Dose of Medication To Get The Desired Effect is WRONG

By Health2 Comments

In recent years the pharmacological principle of prescribing and administering the minimum dose of medication to get the desired effect has become common place in medicine. Despite not being a Doctor or Nurse Prescriber I have come to believe that this approach is fundamentally wrong. In this post I explain why.


The medication that I take each morning.

Let me explain why the theory and practice has become so popular. It has lots of benefits. It helps prevent patients being overdosed on medications, minimises the likelihood and severity of side effects; can prevent or reduce the risk of patients becoming tolerant to medications and microbes from developing drug resistance (such as antibiotic resistance).

These benefits all sound good, so lets looks at the risks and why I believe the risks outweigh the benefits – put simply why I think this approach is wrong.

The biggest risk is that patients get under-dosed, leaving them in pain or suffering due to Doctors and Nurses being too cautious. Another risk is that Doctors and Nurses are always looking to reduce doses at medication reviews. This could be physically, mentally and emotionally harmful to the patient. Some may argue that pathways are in place to prevent under-dosing and harm. But pathways don’t always account for the complexity of the individual patients.

Here are some examples of when this theory of giving the minimum amount of medication to get the desired effect doesn’t work:

  • A patient brakes their arm and has the bone sticking out. They are understandably in a lot of acute pain. However a pathway, Doctor or Nurse may choose to start them on paracetamol and work up to stronger painkillers. In this case the patient is likely to need Morphine, which is at the top of the pain management pathway. This may result in several hours (or more) of severe pain.
  • A patient with chronic back pain attends a Pain Service for medication review. After the initial assessment, the Doctor or Nurse decides to lower doses of medications despite the patient saying that they’re struggling with the pain. They refer to Physiotherapy – a good decision, but still reduce the doses of medications. This leads to anxiety, possible depression and more physical pain.
  • An elderly patient has a urine infection and type 2 diabetes. After several GP visits due to constantly needing the toilet, she gets antibiotics. However they are of the lowest dose, indicated by a urine infection pathway. The patient has to return to the GP to get a higher dose. During this time her blood sugars are high, leading to even more urination, the risk of dehydration and other associated complications of having a high blood sugar over a prolonged period of time.
  • A patient with mental illness such as bipolar isn’t put on high enough doses of antipsychotics and/or antidepressants. They are given the dose that is as little as possible and it is not increased despite the patient asking for this. This means that the patient has continual relapses and repeated admissions to mental health wards.

I try to avoid writing about things that could cause controversy. But my recent 15 day stay in a mental health ward and experience with community mental health services has left me having being given less than the standard doses advised in the BNF on two mood stabilisers. I believe that standard doses of medications exist for a reason. These are levels of medication that experienced clinicians through research have found to be effective.

I now face an uphill struggle and a battle to get medications I need increasing increased due to this theory. This is why I believe it is fundamentally wrong. Because of the risks of under-dosing and causing harm. I’m sure I’m not the only one affected by this principle, it is no doubt many others across the country and Western world.

Write soon,



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Wonderful Websites – General Health

By Health, The WebNo Comments
wonderful-websites-image This is the first blog post in a series titled Wonderful Websites. This post focuses on the most wonderful websites for general health.

1. NHS Choices is crammed with health information. Information on health conditions, treatments, medications, public health issues, carers right, services, practically everything you could ever want to know about health and healthcare in the UK. Delivered by the NHS you can be assured of correct information that is up to date and based on research and evidence.

It has some great online tools such as: BMI Calculator, Mood self-assessment, Sleep self-assessment and many more.

2. has a A-Z list of articles written by doctors, information videos, a symptom checker and an active online community. On more than one occasion while at work in the NHS, I’ve seen doctors checking this valuable website.

3. NetDoctor is similar to Patient.Info, but with more of a focus on healthy living and healthy eating.

4. eMC ( is a useful website for looking up information about medicines.

I use British National Formulary (BNF) but the medical terminology can be difficult for some from a non-medical/non-nursing background to understand; this is why eMC made it on this list instead of the BNF.

5. Office of National Statistics – Health and Social Care is the best place to find statistical information about health. It is regularly updated based on data from the NHS, Local Authories and other Government Departments.

6. National Institute of Clinical Excellence (NICE) provides pathways, guidelines and advice across the UK for best possible evidence-based healthcare. The guidance they provide is developed by groups of clinical experts who provide experience of what works in practice and by examining and analysing research.

If you want to know what care you or a relative or friend should be receiving and check that it’s high quality visit NICE’s website.

7. Health For Teens I found while doing research for this post. It’s specifically aimed at teenagers and looks appealing. They even create content in consultation with young people. I think the name of the website maybe off-putting to young people though – but this is just my personal opinion.

Are there any health websites that you think are useful that aren’t on the list? If so leave a comment below and let me know.

The next post in the Wonderful Websites series will look at websites for mental health and mental illness.

Write soon,



I aim for posts on this blog to be informative, educational and entertaining. If you have found this post useful or enjoyable, please consider making a contribution by Paypal:

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