Junior doctors 'pose risk over prescriptions'

Published on Monday 2 February 2009 18:47

PATIENTS are at risk because new doctors are unprepared for the task of prescribing drugs, according to a leading medicines expert.

Professor David Webb, professor of clinical pharmacology at Edinburgh University, said he had warned for several years that young doctors were not being given enough tuition in prescribing to ensure medicines were used safely.

Only now – more than eight years since concerns were first raised – are guidelines on the medical curriculum set to address the problem.

The General Medical Council's own research found there was "significant potential risk" caused by prescribing mistakes made by junior doctors. But firm figures linking these mistakes back to training are currently lacking.

Prof Webb, who gave evidence to MPs at Westminster recently, said any changes made to drugs training must include an assessment of medical students to make sure they are able to prescribe medicines safely.

His warning followed a report that showed there was a five-fold increase in drug- prescribing errors between 1990 and 2000. This covered the period after 1993 when changes to the UK training programme meant many students received less teaching about prescribing.

"There's a concern, which has been growing for a number of years, that with the document produced in 1993 by the GMC, which radically shook up teaching in medical schools, one of the losers in that process was teaching about medicines and how to use medicine, including prescribing," Prof Webb said. "Pharmacology, which is the science underpinning the use of medicine, has been largely lost from medical schools.

"Teaching in clinical pharmacology, which is the way that you translate that and learn to use medicines, has been substantially reduced and lost in some medical schools.

"And the practical prescribing that was done by medical students under supervision disappeared at the same time."

Research carried out by the GMC, involving medical schools in Glasgow, Warwick and Newcastle, raised significant concerns around prescribing among medical graduates. The study found weaknesses in their general knowledge about drugs, in their ability to calculate doses and in writing prescriptions, with concerns reported by pharmacists working with young doctors.

"Prescribing was also the main area of practice in which errors were reported by respondents, indicating a significant potential risk," the GMC report said.

Prof Webb, a former chairman of the Scottish Medicines Consortium, said after concerns were first raised in about 2001, the British Pharmacological Society carried out its own research among 2,500 students in 2006.

This found the vast majority were not ready to prescribe when they began work as newly qualified doctors.

Prof Webb said because drugs were becoming more complex, and elderly people could be taking many drugs at one time, new doctors needed to be better prepared for prescribing as well as possible medicine interactions.

"It's a fairly steep learning curve at the moment for newly qualified doctors in terms of what they are doing in prescribing," he said. "Those who supervise junior doctors need to make sure there is a focus on what they prescribe to help avoid problems."

Prof Webb said the draft of new medical training guidance from the GMC indicated a renewed focus on prescribing. But he cautioned that this had to be backed up with testing to make sure new doctors were ready to prescribe.

"To ensure that medical students really focus on prescribing, they need to be assessed in their abilities to do it, and that is perhaps something that has not been tied down as yet, but is really important," he said. "We know that students focus most on the things they get examined about. Some evidence has to be collected that they are up to scratch."

Professor Peter Rubin, chair of the GMC's education committee, said his organisation had responded very quickly to concerns about prescribing training for junior doctors.

"We asked students what they would find helpful, and they said they would like more practical experience, such as writing prescriptions, working out doses and so on," he said. "Most medical schools in the UK have acted upon this."

Prof Ruben said the GMC was currently carrying out a 100,000 study to track the sources of prescribing errors, and it will examine whether they could be traced back to medical training.

John Hallett, who chairs the British Medical Association's Scottish medical students committee, said: "It is a concern among medical students that they lack the experience and knowledge of prescribing when they start the job. The only way to gain this knowledge is to do the job, and the only way to cut down on prescribing errors is to have a pharmacist on every ward, but the resources are not available for that."

He added that prescribing errors were not a common reason for doctors being reported to the GMC.