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March 11, 1974

"As Directed"

JAMA. 1974;227(10):1123. doi:10.1001/jama.1974.03230230015010

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To The Editor.—  In the article by three pharmacists on inadequately written prescriptions (226:999, 1973), the practice of the "as directed" is attacked. It is good to look at the other side of the drug counter at the practitioner's side.For instance, psychiatric prescribing, a proportion of it long-range, is subject to frequent dosage and similar changes throughout the course of treatment, thus making original label inscriptions inapplicable. Experience has shown again and again that such fixed label directions become confusing, especially if the medication has been interrupted for a while and then resumed. Some of us also have had cases where labelling that directs bedtime use of other than sleeping medicine—quite frequent today in psychiatric prescribing—has later led patients or their relatives to dose themselves with various substances for insomnia.It goes without saying that directions should be written out separately for the patient and dated; note-taking is insisted