Wording Indications for Sensitive Conditions

Which conditions are sensitive?

The site gives examples rather than a list. FAQ 4 names patients with epilepsy and patients with cancer. Feedback at the pilot practice made the wider point: “Some people may not want others to know their health details” (FAQ 14).

Should the patient be asked?

Yes. FAQ 4: “Certain clinical indications cover sensitive issues and patients should be asked if they are in agreement with placing an item of information on the prescription list.”

The same FAQ suggests mentioning clinical indications in the practice leaflet, in the repeat prescribing section, stressing the safety benefits.

What if the patient says no?

A note of the patient’s preference goes on the repeat prescription in place of the indication. The wording to use is “patient preference no indication” (FAQ 4).

Few patients chose it at the pilot practice. In three years, two patients asked to change their indication wording, and two others asked for no indication (FAQ 14).

Who might see the indication?

Possibly anyone who sees the medicine packet. FAQ 4 explains that pharmacists record the indication with the directions, so packages left visible in shared accommodation could be seen by others. Patients can be advised to be more discreet with their medicines. In a care home, the indication is also placed on the medicine administration record used by care staff (FAQ 15).

Writing in 2006, the FAQ looked ahead to a box on the prescription that the prescriber could tick to tell the pharmacist not to write the indication on the label.

Today there is no separate indication field. The indication is written into the directions, so it is printed on the pharmacy label with them, and Dr Masters does not know of a way to keep it off the label while keeping it in the record. A patient who wants it kept private can have the opt-out note, or a more general phrase (below).

Can the wording be discreet instead?

Yes. For a patient who wants an indication but not a diagnosis on the label, a more general phrase is an option, such as tamoxifen “to prevent recurrence of disease”. The Sample Directory shows the wording it used. None of its 568 entries contains the word “cancer”. Tamoxifen, which FAQ 5 mentions in connection with breast cancer, has two entries: “to prevent breast disease recurrence” and “to prevent recurrence of disease”. Epilim appears as “to prevent epilepsy”, and Epilim chrono MR as “to prevent fits”.

What is lost by leaving it off?

The safety benefit the site argues for. FAQ 4 opens by saying that clinical indications “provide clear guidance as to why a drug has been prescribed and therefore enhance patient safety”. The choice still rests with the patient, who should be asked before a sensitive indication is added.

Patients and carers: see knowing what each medicine is for and asking your GP practice. Prescribers: see how to write a good indication.

If you have questions about your medicines, ask your GP practice or pharmacist.