Doctor Compliance

Doctor compliance is the extent to which the behaviour of doctors fulfils their professional duty:

• to adopt new advances when they are sufficiently proved (which doctors are often slow to do)

• to prescribe accurately51

• to tell patients what they need to know

50 Hippocrates (5th cent, bc) noted that patients are liars regarding compliance. The way the patient is questioned may be all-important, e.g. 'Were you able to take the tablets?' may get a truthful reply where, 'Did you take the tablets?' may not, because the latter question may be understood by the patient as implying personal criticism (Pearson R M 1982 British Medical Journal 285: 757).

• to warn, i.e. to recognise the importance of the act of prescribing.

In one study in a university hospital, where standards might be expected to be high, there was an error of drug use (dose, frequency, route) in 3% of prescriptions and an error of prescription writing (in relation to standard hospital instructions) in 30%. Many errors were trivial, but many could have resulted in overdose, serious interaction or under-treatment.

In other hospital studies error rates in drug administration of 15-25% have been found, rates rising rapidly where four or more drugs are being given concurrently, as is often the case; studies on hospital inpatients show that each receives about six drugs, and up to 20 during a stay is not rare. Merely providing information (on antimicrobials) did not influence prescribing, but gently asking physicians to justify their prescriptions caused a marked fall in inappropriate prescribing.

On a harsher note, of recent years, doctors who have given drugs, of the use of which they have later admitted ignorance (e.g. route of administration and/ or dose), have been charged with manslaughter52 and have been convicted. Shocked by this, fellow doctors have written to the medical press offering understanding sympathy to these, sometimes junior, colleagues; 'There, but for the grace of God, go I'.53 But the public response is not sympathetic. Doctors put themselves forward as trained professionals who offer a service of responsible, competent provision of drugs which they have the legal right to prescribe. The public is increasingly inclined to hold them to that claim, and, where they seriously fail, to exact retribution.54

If you don't know about a drug, find out before you act, or take the personal consequences, which, increasingly, may be very serious indeed.

51 Accuracy includes legibility: a doctor wrote Intal (sodium cromoglycate) for an asthmatic patient: the pharmacist read it as Inderal (propranolol): the patient died. See also, Names of drugs.

52 Unlawful killing in circumstances that do not amount to murder (which requires an intention to kill), e.g. causing death by negligence that is much more serious than mere carelessness; reckless, breach of the legal duty of care.

53 Attributed to John Bradford, an English preacher and martyr (16th cent), on seeing a convicted criminal pass by.

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