5 Must Know Mistakes – How to Write Medication Recommendations to Primary Providers

How to write medication recommendations is a question I frequently address with students.  While understanding that there are various formats, processes, and different ideas on this topic, I believe that there is quite a bit of art in medication recommendation writing.  Here’s 5 tips that can help you write better recommendations!


  1. Don’t insult.  This seems obvious, but snotty or snide remarks serve no purpose.  You are trying to persuade one of your healthcare colleagues to do what you want them to do.  By insulting someone, you are not getting off on the right foot.
  2. Identify a legitimate concern.  You have to have a problem to write a recommendation.  A recommendation is not meant to be simply an educational session.  You have to convince a provider that a recommendation you write is because of a significant concern.
  3. Provide a solution. This is a huge issue for providers and you can make them very frustrated by not providing a solution.  Simply stating that a drug “should not be used” is not a solution.  If you are requesting to discontinue metformin because of adverse effects or poor kidney function, you better present ideas on how to solve their hyperglycemia when it is discontinued.
  4. Providing multiple options.  This can be an effective strategy as it allows the primary provider to still feel as if they have options, not just an either or scenario.
  5. Be prepared for failure. I would say the majority of medication recommendation I write are accepted, however, caring healthcare professionals can disagree, and unless you deem that a problem is potential life threatening or could lead to serious, learn how to respectfully let it go with a smile on your face.

Interested in more information on this topic?  I created a 3 hour webinar full of my real world experiences writing thousands of recommendations to hundreds of different providers.


  1. Cole

    Love #3 – I find too many students on the beginning of my rotation in the Emergency Dept are quick to try and stop orders because, “[Drug Interaction Software] said it’s a Red X” or what have you. That’s perfectly fine, but what do you recommend instead? Long pause followed by, “I didn’t think about that.” A DDI alert is where clinical pharmacy begins, not where it ends.
    Recently had a student who wasn’t quite ‘getting it’ try to stop cephalexin because patient was on carbamazepine – I appreciate they are thinking of the whole patient but beta-lactams are safe even in patient’s with seizure disorders (I asked to see some primary literature and was handed a paper on Imipinem-Cilastin… uggg). The student still wanted to move forward with their recommendation and was shut down. I’m happy to let students fail on my rotation, and they will – EM is too fast paced to get everything right. Could’ve been a nice turning point for our learning experience… alas, it was not.

    • Eric Christianson

      That’s a great way to put it! Thanks for sharing!


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Written By Eric Christianson

February 28, 2016

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