What constitutes good prescribing?

Drugs are the mainstay of medical treatment, yet there are few reports on what constitutes "good prescribing." What is more the existing guidance tends to imply that right answers exist, rather than recognising the complex trade offs that have to be made between conflicting aims. This paper proposes four aims that a prescriber should try to achieve, both on first prescribing a drug and on subsequently monitoring it. They are: to maximise effectiveness, minimise risks, minimise costs, and respect the patient's choices. This model of good prescribing brings together the traditional balancing of risks and benefits with the need to reduce costs and the right of the patient to make choices in treatment. The four aims are shown as a diagram plotting their commonest conflicts, which may be used as an aid to discussion and decision making.