Mini Review

Rational use of medicines: Role of the future physician

Md Tausif Alam ^1*

¹ Malabar Medical College and Hospital, Ulliyeri, Kozhikode, 673323, Kerala, India.

* Correspondence: mohammadtausif801@gmail.com (M.T.A.)

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Citation: Alam, M.T. Rational use of medicines: Role of the future physician. Glob. Jour. Bas. Sci. 2025, 1(9). 1-5.

Received: March 21, 2025

Revised: June 28, 2025

Accepted: July 22, 2025

Published: July 22, 2025

doi: 10.63454/jbs20000049

ISSN: 3049-3315

Volume 1; Issue 9

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Abstract: The rational use of medicines (RUM) is a cornerstone of effective, safe, and economical healthcare. Despite global efforts, irrational prescribing, dispensing, and consumption of medicines remain major challenges, contributing to adverse drug reactions, antimicrobial resistance, therapeutic failure, and unnecessary healthcare costs. Future physicians play a pivotal role in promoting rational medicine use through evidence-based prescribing, patient-centered care, ethical decision-making, and interprofessional collaboration. This mini-review highlights the concept of rational use of medicines, current challenges, consequences of irrational use, and the evolving responsibilities of future physicians in ensuring optimal pharmacotherapy.

Keywords: Rational use of medicines; prescribing practices; future physicians; patient safety; antimicrobial resistance

1. Introduction

Medicines represent one of the most powerful and transformative interventions in modern healthcare, serving as indispensable tools for the prevention, diagnosis, and treatment of a vast spectrum of diseases. Their discovery and development have dramatically reduced mortality, alleviated suffering, and improved the quality of life for billions of people worldwide. From antibiotics that combat deadly infections to antihypertensives that prevent strokes and chemotherapeutics that target cancer, pharmaceuticals are central to the practice of medicine and the functioning of health systems. However, the immense potential of these agents to do good is intrinsically linked to their appropriate application. The therapeutic benefit, safety, and cost-effectiveness of any medicine are not inherent properties of the drug itself, but are critically dependent on the principles of rational use: the correct selection of the most suitable medication for a specific patient and condition, the administration of doses tailored to individual physiological and pathological characteristics, the adherence to an adequate duration of therapy, and the implementation of diligent monitoring for both efficacy and adverse effects. When these principles are disregarded, the consequences extend beyond therapeutic failure to include patient harm, the propagation of antimicrobial resistance, and the wasteful expenditure of limited healthcare resources.

Recognizing this fundamental relationship between use and outcome, the World Health Organization (WHO) has established a definitive framework for the optimal application of pharmaceuticals. The WHO defines the rational use of medicines as a situation in which “patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and the community” [1]. This concise yet comprehensive definition encapsulates the core objectives of safe, effective, and efficient pharmacotherapy, balancing clinical precision with socioeconomic responsibility. It emphasizes that rational use is patient-centered, evidence-based, and context-aware.

Despite this clear guideline and decades of global advocacy, irrational use of medicines remains a pervasive and deeply entrenched challenge in health systems across the world. This phenomenon is not confined by economic boundaries; it is prevalent in both developed and developing countries, though it may manifest differently. Common forms of irrational use include polypharmacy without clear indication, the overuse of antibiotics for viral infections, the underuse of life-saving medications for chronic conditions, a preference for newer, more expensive drugs when older, equally effective alternatives exist, and the inappropriate use of injectable formulations where oral therapies would suffice. The drivers of this irrational use are complex and multifactorial, involving gaps in prescriber knowledge and training, patient demands and misconceptions, aggressive pharmaceutical marketing, profit-driven incentives in supply chains, and weaknesses in regulatory and policy frameworks.

As healthcare systems continue to evolve, facing pressures from aging populations, the rise of chronic diseases, and escalating costs, the role of the physician as the primary gatekeeper of medicine use becomes more critical than ever. Future physicians will practice in an environment of increasing therapeutic complexity, rapid biomedical innovation, and heightened accountability for outcomes and value. Therefore, their education must equip them not only with diagnostic acumen and knowledge of pharmacodynamics but also with the competencies to prescribe rationally: the ability to critically appraise evidence, apply clinical guidelines judiciously, communicate effectively with patients about benefits and risks, understand pharmacoeconomics, and function as stewards of shared healthcare resources. Cultivating these competencies from the earliest stages of medical training is paramount to addressing the global public health issue of irrational medicine use and ultimately fulfilling the promise of safe, effective, and accessible healthcare for all.

2. Concept and principles of rational use of medicines

The rational use of medicines (RUM) is a foundational pillar of clinical pharmacology and safe healthcare, representing the systematic application of a decision-making framework that integrates scientific evidence, clinical expertise, and patient-centered values. At its core, RUM is not merely about administering drugs but about executing a therapeutic strategy that maximizes benefit while minimizing risk and waste. This process is built upon several interdependent principles. It begins with an accurate and timely diagnosis, as initiating treatment without a clear understanding of the pathology is inherently irrational. Following diagnosis, the selection of a therapeutic agent must be appropriate, considering the drug’s efficacy for the specific condition, the patient’s individual characteristics (age, comorbidities, genetics), potential allergies, and cost-effectiveness. The subsequent principles involve correct dosing, which accounts for pharmacokinetic variables like renal and hepatic function; adequate duration of therapy to ensure eradication of infection or control of a chronic condition without promoting resistance or toxicity; and consistent monitoring for therapeutic effectiveness and adverse drug reactions. To operationalize these principles in daily practice, healthcare systems rely on key supportive tools. Standard treatment guidelines provide evidence-based, condition-specific prescribing pathways. Essential medicines lists, such as the WHO Model List, prioritize the most efficacious, safe, and cost-effective drugs for a health system’s core needs. Evidence-based clinical protocols standardize care for common scenarios, reducing unwarranted variation. Adherence to this structured, principled approach is what ensures optimal therapeutic outcomes, prevents patient harm, and promotes the efficient use of limited healthcare resources (Figure 1). 

Figure 1. Role of the future physician in rational use of medicine.

3. Global burden of irrational use of medicines

Despite well-established principles, the irrational use of medicines remains a pervasive global public health crisis of staggering scale. World Health Organization estimates indicate that more than half of all medicines worldwide are prescribed, dispensed, or sold inappropriately, and concurrently, 50% of all patients fail to take their medications correctly [3]. This dual failure in the prescribing and consumption phases of the medication use process signifies a systemic breakdown. Common manifestations of irrational use are widespread and include polypharmacy, where patients are prescribed an excessive number of medications without clear therapeutic goals; the overuse of antibiotics for viral infections, fueling antimicrobial resistance; the inappropriate  preference for injectable formulations when oral therapies would be safer and equally effective; and rampant self-medication with prescription drugs, often without accurate diagnosis. Furthermore, a significant volume of prescribing occurs without adherence to clinical guidelines, driven by habit, misinformation, or commercial influence. While the magnitude of the problem is particularly acute in low- and middle-income countries, often exacerbated by weaker regulatory systems and fragmented care, it is a misconception that high-income countries are immune. In affluent settings, irrational use often takes the form of over-prescription of branded drugs, unnecessary psychotropic medications, and the treatment of marginal clinical indications, leading to substantial economic waste and patient harm [4]. This universal prevalence underscores that irrational use is not merely a resource issue but a fundamental challenge in clinical practice and health system design.

4. Consequences of irrational medicine use

The repercussions of irrational medicine use are profound and multifaceted, spanning clinical, economic, and public health domains, and collectively they impose a heavy burden on societies. Clinically, inappropriate prescribing directly leads to increased rates of adverse drug reactions (ADRs) and dangerous drug-drug interactions, which are major causes of morbidity, hospital admissions, and mortality [5]. Therapeutic failure is another direct consequence, as patients receive drugs that are ineffective for their condition, at sub-therapeutic doses, or for an insufficient duration, leading to prolonged illness, complications, and loss of trust in the healthcare system. From a public health perspective, the most alarming consequence is the acceleration of antimicrobial resistance (AMR). The misuse and overuse of antibiotics in human and animal health create selective pressure that drives the evolution of resistant pathogens. AMR now threatens to render common infections untreatable, undermine modern medical procedures like surgery and chemotherapy, and is recognized by the WHO as one of the top ten global public health threats [6]. Economically, the impact is colossal. Irrational prescribing inflates healthcare expenditures through the direct cost of unnecessary or overly expensive medications, the indirect costs of managing ADRs and therapeutic failures (including prolonged hospital stays and additional diagnostic tests), and the long-term economic devastation posed by widespread AMR [7]. These consequences create a vicious cycle, straining health systems and diverting resources away from effective and necessary care.

5. Role of the future physician in promoting rational use

5.1 Evidence-based prescribing

The future physician must be a master of evidence-based prescribing, a skill that transcends rote memorization of drug names. This requires the ability to critically appraise clinical research, integrate the best available external evidence from systematic reviews and guidelines with individual clinical expertise, and carefully consider unique patient values and circumstances [8]. Familiarity with and regular use of institutional formularies and essential medicines lists are not administrative tasks but acts of clinical and economic stewardship, ensuring choices are both scientifically sound and sustainable for the health system.

5.2 Patient-centered care and communication

Rational use is impossible without patient understanding and collaboration. Future physicians must prioritize effective, empathetic communication to educate patients about the precise indication for a medication, its expected benefits, potential risks, correct administration, and the importance of adherence [9]. This involves shared decision-making, where patients are active partners, and counseling that addresses concerns and misconceptions. A well-informed patient is the most powerful safeguard against misuse and non-adherence.

5.3 Ethical and professional responsibility

Prescribing is an ethical act. Future physicians must cultivate the professional fortitude to resist external pressures that conflict with patient welfare. This includes inappropriate influence from pharmaceutical marketing, yielding to patient demands for unnecessary medications (like antibiotics for viral colds), or systemic pressures for rapid patient turnover that discourages thorough evaluation. Ethical prescribing demands that the patient’s best interest is the sole and overriding priority [10].

5.4 Antimicrobial stewardship

As frontline prescribers, future physicians are crucial soldiers in the fight against AMR. This involves embracing the role of an antimicrobial steward: prescribing antibiotics only when clearly indicated, selecting the right drug, dose, and duration, and adhering to hospital or community stewardship protocols [11]. It also encompasses advocating for and practicing robust infection prevention and control measures to reduce the need for antibiotics in the first place.

5.5 Lifelong learning and digital health

The landscape of pharmacology is dynamic. Commitment to continuous professional development is non-negotiable for maintaining prescribing competence. Furthermore, future physicians must be adept at leveraging digital health tools, such as clinical decision support systems (CDSS) integrated into electronic health records, which can provide real-time alerts for allergies, dosing errors, and drug interactions, thereby enhancing safety and supporting guideline adherence [12].

6. Medical education and training for rational prescribing

Bridging the gap between knowledge of pharmacology and competent prescribing requires a deliberate and robust educational strategy. Undergraduate and postgraduate medical curricula must move beyond theoretical pharmacology to emphasize applied therapeutics and practical prescribing skills. This can be effectively achieved through problem-based learning scenarios that simulate real-world diagnostic and therapeutic dilemmas, structured case discussions that explore the rationale behind prescribing choices, and hands-on simulated prescribing exercises using paper or electronic prescribing platforms. Evidence indicates that such interactive, contextualized training, particularly during the clinical clerkship and internship years, significantly improves the rational prescribing behavior of medical students and new doctors, building the foundational habits necessary for a safe prescribing career [13–15].

7. Challenges faced by future physicians

Even well-trained physicians with the intention to prescribe rationally will encounter significant systemic and contextual barriers. These include intense time constraints during consultations that hinder thorough medication reviews and patient education, inadequate access to up-to-date, unbiased treatment guidelines at the point of care, patient expectations and demands for specific (often unnecessary) medications fueled by direct-to-consumer advertising or internet searches, and overarching health system limitations such as drug stock-outs or restrictive formularies [16]. Overcoming these challenges cannot be the burden of the individual physician alone; it requires institutional support (e.g., providing access to digital guidelines), supportive policy interventions (e.g., regulating pharmaceutical promotion), and a culture of interprofessional collaboration where pharmacists, nurses, and physicians work as a team to optimize medication therapy.

Addressing the global challenge of irrational medicine use demands a concerted, multi-pronged strategy. Strengthening medical education is the first pillar, ensuring curricula produce not just diagnosticians but skilled therapeutic decision-makers. The second pillar involves stronger regulation and policy, including enforcement of ethical marketing codes, public awareness campaigns, and policies that incentivize rational prescribing. The third is the strategic integration of technology, such as widespread implementation of e-prescribing with CDSS and robust national pharmacovigilance systems. Central to all these efforts is the imperative to empower future physicians with not only deep pharmacological knowledge but also the ethical grounding, communication skills, and system-thinking required to navigate complex healthcare environments. They must be equipped to be leaders and change agents for sustainable healthcare systems [17,18].

8. Conclusion

The rational use of medicines is far more than a clinical guideline; it is a fundamental determinant of patient safety, healthcare quality, and economic sustainability. Future physicians stand at the very center of this endeavor. Their daily decisions at the prescription pad have cumulative effects on individual patient outcomes and global health trajectories. Promoting rational use is therefore a core professional duty, achievable through relentless commitment to evidence-based practice, genuine patient engagement, and unwavering ethical responsibility. Reinforcing these critical competencies during the formative years of medical education and supporting their continuous development throughout a physician’s professional life is an essential investment. It is the most direct path to mitigating the pervasive and costly problem of irrational medicine use and fulfilling the promise of safe, effective, and equitable healthcare for all populations.

Author Contributions: Conceptualisation, M.T.A.; software, M.T.A.; investigation, M.T.A.;  writing—original draft preparation, M.T.A.; writing—review and editing, M.T.A.; visualisation, M.T.A.; supervision, M.T.A.; project administration, M.T.A. The author has read and agreed to the published version of the manuscript.

Funding: Not applicable.

Acknowledgments: We are grateful to Malabar Medical College and Hospital, Ulliyeri, Kozhikode, 673323, Kerala, India. for providing us all the facilities to carry out the entire work.

Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.

Data Availability Statement: All the related data are supplied in this work or have been referenced properly.

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