Surviving Prescribing: A Practical Guide, 2nd Edition

Book Title: Surviving Prescribing: A Practical Guide, 2nd Edition

Authors: Mayur Murali, Robert Shulman, and Hugh Montgomery

Publication Information: Cambridge, UK, Cambridge University Press, 2020, 233 pp, $21, paperback

Surviving Prescribing is touted as a practical guide for “real-world prescribing problems” for the hospital-based new prescriber (p. i). Edited by the trio of Mayur Murali, Robert Shulman, and Hugh Montgomery, whose respective combined backgrounds include those of anesthesia trainee, clinical pharmacist, and intensivist, the editors have contributed chapters to the work in addition to multiple other authors who are primarily pharmacists and physicians. As the authors practice in the United Kingdom, multiple drug options are suggested that may not be available in other countries. Furthermore, the online resources mentioned throughout the book are probably most helpful for UK-based prescribers but likely are less useful references for a global audience.

Organized into more than 40 chapters, each of the 11 sections is designed to be a quick read. High-yield facts are highlighted in tables with interspersed mnemonics in order to promote retention. Mortality data are also sprinkled across various chapters, highlighting the importance of prudent management. Notably, several chapters are particularly helpful for the new prescriber, including “Pregnancy Prescribing” and “Electrolyte and Metabolic Emergencies,” as well as the “Surgery” section. As a seasoned prescriber, I especially enjoyed the “Interactions That Matter” chapter as it taught me several new interactions, and the “Intravenous Therapies” chapter detailed information that I’ve never seen explicitly discussed in any general textbook or pocket guide.

Unfortunately, though, the work does not seem to embrace the role of the primary care physician. For example, in the special populations section, the pediatric chapter explicitly states that only pediatricians should fill the role of pediatric prescriber; similar advice is given in the geriatric prescribing chapter as well. In fact, the paracetamol overdose chapter outright states that this the not the place to “discuss management extensively” at all (p. 49). Specialist consultation seems to be the prevailing recommendation for management of most conditions; therefore, utility is definitely lacking for the primary care physician.

Overall, each chapter provides a broad overview of prescribing in selected conditions. However, the bulk of the information is not of sufficient detail to assist with acute management of conditions beyond the initial patient presentation. Remarkably, considering that this is a prescribing guide, chapters actually inconsistently mention any drug classes, doses, or prescribing recommendations whatsoever.

Though I appreciate humor as much as anyone, a prescribing guide is not an ideal setting for this form of writing. For example in the “Delirium Tremens and Alcohol Withdrawal” chapter, the author unsuitably mentions that giving a larger dose of sedation at nighttime can ensure a quiet night for the entire ward.

Additionally, the theme of the book becomes confusing at various points as it seems to transition from prescribing guide to an in-depth exploration of pathophysiology and drug mechanisms of action. However, this exploration is inconsistent among the chapters. The writing style of each chapter also varies greatly. For instance, some chapters are written as clinical vignettes while others primarily consist of tables or algorithms. While the tone of most chapters is serious, some may be construed as comical or outright offensive, depending upon the sentiment of the reader. For example, the “Nausea and Vomiting” chapter encourages the reader to imagine a night of heavy alcohol intake to illustrate symptom cause and therapy selection. Overall, these inconsistencies may be off-putting to readers who expect consistent rhetoric from one chapter to the next, but may actually be interesting or entertaining to others.

So, for whom is this book best suited? The answer is, quite frankly, not readily apparent. When considering the overall depth of the material, it is probably best suited to a medical student on clinical rotations as an introduction to prescribing. At this level of training, however, many of the concepts would be difficult to understand without more foundational medical knowledge (which the book will not provide).

Upon encountering this book, my initial thought was, “Surviving Prescribing, where have you been all of my life?” However, the ultimate execution proved to be little more than an ambitiously broad overview of important, though for the most part, superficially covered topics.