Introduction

Reviews

How Well Does Your Doctor Prescribe Drugs?

Timothy B. McCall, M.D.

Doctors vary incredibly in how they prescribe drugs. Some prescribe drugs sparingly. Others give them out like candy at Halloween. My medical training allows me to examine a list of a patient’s medications and surmise a lot about the prescribing physician. I can often guess if a doctor is out-of-date, overly influenced by drug companies or oblivious to the cost of drugs. Even without any medical background, you can learn to make similar determinations. All you need is a basic understanding of how drugs should and should not be prescribed.

In order to prescribe a drug appropriately, a doctor must understand how it’s supposed to be used. Before writing a prescription, doctors should ask themselves a few questions. Is the drug appropriate for the condition in question? What dose should be used? How many times per day should it be taken? For how long? What side effects are possible? Will the drug interact with other drugs the patient’s taking?

With the multitude of drugs available these days, no doctor can know them all. Good doctors know a lot about the drugs they frequently prescribe and read about unfamiliar ones before prescribing them. Obviously, not all doctors take the time to do so.

The Physician Insurers Association of America analyzed almost 400 recent malpractice claims due to medication errors to find out which errors were most common. In most cases, the doctor involved had made more than one error. The most common errors made and their frequency are listed below:

Type of Error	Frequency
Incorrect dose	27.2%
Inappropriate drug for the condition	24.9%
Failure to monitor for side effects	20.6%
Poor communication by doctor	18.1%
Failure to monitor drug levels	13.2%
Lack of knowledge about drug	13.2%
Most appropriate drug not used	13.0%
Inappropriate length of treatment	12.7%
Failure to monitor drug’s effectiveness	12.5%
Inadequate medical history (interview)	12.2%
Inadequate notes in the patient’s chart	9.9%
Failure to notice patient allergic to drug	9.7%

While some of the errors involved drugs the doctors were not very familiar with, the vast majority involved the drugs the doctors used most. What the insurance companies found most alarming was that almost all of the errors were completely avoidable.

Although prescribing drugs is one of the main duties of the physician, medical students receive relatively little training in pharmacology, the science of drugs. In fact, many drug company promotional representatives have more training in pharmacology than the average doctor.

Since new drugs are being introduced all the time, a doctor who has been out in practice for 10 years may be prescribing dozens of drugs for which he or she has no formal training. Many doctors will, of course, educate themselves about any new drug they prescribe. Others rely on information they read in advertisements or hear from drug company representatives. Still others prescribe drugs they know little about.

All this means that to protect yourself from drug errors you need to pay attention to what your doctor is doing. You cannot assume that just because someone has a long white coat and an M.D. after there name that everything will be fine. Over the next several weeks we will discuss what to look for.

Next: Before Taking a Drug, Make Sure the Diagnosis is Correct

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