Abstract
You see a 42-year-old man in your surgery. He is on methotrexate for rheumatoid arthritis, which is prescribed by you under shared care guidelines. Despite repeated explanations regarding the importance of monitoring blood tests by you and the hospital consultant, he frequently attends for these late and asks for prescriptions on the proviso that he will have a blood test in the near future. You feel very uncomfortable with these requests. When you explain this to him, he gets angry saying that you are trying to deny him his important medication.
British Society for Rheumatologists. Retrieved from: www.rheumatology.org.uk/includes/documents/cm_docs/2099/d/diseasemodifying_antirheumatics_drug_dmard_therapy.pdf
Department of Health— Shared Care Guidelines. Retrieved from: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4898588
General Medical Council. Guidelines Undergoing Review — Draft Consultation. Retrieved from: www.gmc-uk.org/Good_practice_prescribing_consultation_draft_FINAL.pdf_40006888.pdf
National Patient Safety Agency. Retrieved from: www.nrls.npsa.nhs.uk/resources/?entryid45=59800
National Prescribing Committee. Retrieved from: www.npc.nhs.uk/developing_systems/shared/resources/5mg_sc.pdf
How would you approach this case and who would you discuss him with?
Where can you access the shared care guidelines?
How would you approach further discussion of this issue with the patient?
His subsequent blood test reveals a white cell count of 2.8 × 100/l. The hospital rheumatologist requested this test and sent a copy of the results to you.
What is the significance of this result and whose responsibility is it to action it?