Physicians: errors

German physician Julius Robert Mayer. Mayer s work, although historically important for its insights into the conservation-of-energy principle, was however tainted by errors in physics and an unacceptable reliance on philosophical arguments. 

Elsewhere, it was found that errors by physicians and others is often not reported to patients, and surprisingly, 23% of physicians and 11% of patients in one study did not feel that physicians should report such errors to patients.15 Clinicians in the future will be expected to interact more, and more effectively, with patients. These expectations for improved interaction with patients will help both clinicians and patients to reach their therapeutic goals. The authors of the chapters in this text have worked through patient care problems that are commonly seen in practice, and the reader will benefit by using similar tactics to help their patients. 

Pharmacogenomics will further expand the responsibility of pharmacists to screen prescriptions, because physicians will have more opportunities for error in prescribing, just as pharmacists will have more opportunities for error in dispensing. Knowing whether the physician has written a prescription correctly for a patient will require that pharmacists evaluate patient-specific genetic information in addition to the other patient-related information that pharmacists currently have available for analysis. This may... 

The PIAA conducted a medication-error study in 1993 ° and another in 1999 to analyze high-frequency and severe malpractice claims. The data collected included loss description and causation information, expense and indemnity payments, and the demographics of policyholders, claimants, and institutions. The PIAA companies insured almost 87,000 physicians in the United States, ranging from the smallest to the largest physician-owned malpractice insurers. 

Physician Insurers Association of America, Medication Error Study, PI A A, Washington, DC, June 1993. 

Since the last edition of this book was published, a plethora of new updating information has become available on the internet. The sheer volume of this is such that it is beyond the reach of this chapter. Attempts to create a standard set of procedures and requirements in the new and enlarged European Union have certainly made progress although the pharmaceutical physician will have to consult the most recent regulations and guidelines if errors are to be avoided. Even such basic concepts as a suspected serious adverse reaction may vary between countries. 

Finally, while total promotion expenditures over all types of promotional efforts approximately doubled between 1996 and 2001 (Table 9.1), so too did revenues, and thus total promotional intensity remained relatively constant. The total promotion-to-sales dollar ratio has hovered between 14% and 16% between 1996 and 2002, but it appears to have increased tol7.1% in 2003. This most recent increase may reflect the rising relative importance of free samples provided physicians, which in large part (Table 9.1), as noted above, are evaluated at their full retail prices rather than at marginal production costs. The apparent increases might also simply reflect the effects ofvarious measurement errors. 

It has been shown that computerized physician order entry substantially decreases the rate of non-missed-dose medication errors. 

Most drug-induced illness comes about through one of four mechanisms (a) poor prescribing decisions by physicians, despite the availability of clear evidence (b) errors in dispensing or administration... 

Note The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. 

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