Robert Naylor

Radcliffe Medical Press, £29.95, pp 344

ISBN 1 85775 956 7

Rating:

Like many who have made an in-depth examination of medical error, Robert Naylor seems to have been profoundly affected by his explorations. This is a book that charts the literature on medication errors and displays a passion shared by Harvard professor Lucian Leape and others in arguing that we can and must do more to stop harming patients (BMJ 2000;320:725-6)[Free Full Text].

Naylor notes that his concern "to report and then reduce drug-induced adverse events and medication errors has opened a Pandora's box," and this is indeed the case. What starts as a detailed overview of the literature and policy context of medication errors develops into an indictment of the current system of medical education and a call to ensure that prescribers have a much better grounding in pharmacology and therapeutics.

Anyone who has followed the literature on medication error will know that tackling system failure, rather than blaming individuals, is seen to be the best approach to improving safety. Naylor does not challenge this notion, but he points out forcefully and repeatedly that the commonest cause of medication error is lack of knowledge among healthcare professionals. Such errors may be couched in terms of systems failure but Naylor argues that anyone "who advances on a patient armed with a drug in the absence of a knowledge of its use is grossly irresponsible."

Naylor's concerns lead him to a detailed examination of medical curriculums in which he argues that recent trends have diverted attention away from providing doctors with essential knowledge of pharmacology and therapeutics to focusing on wider societal concerns. He argues that the pendulum has swung too far in this direction and that a reduction in the factual content of courses "has given rise to serious concern about future competence."

This book provides a detailed summary of the literature on medication errors and will prove useful to many health professionals and academics. As a single author, Naylor has performed an impressive feat in covering the topic. There are, however, areas where the book could have been improved by bringing in other experts in the field. In particular, while he makes important points about the deficiencies of medical education, I thought that his answers to the problem were not well developed. Nevertheless, I found it refreshing to have an author write so passionately about his subject. While Naylor recognises that various interventions can help to prevent medication errors he remains convinced that potential prescribers need much better training before they are set loose on patients.

Tony Avery, head of division of primary care. 

School of Community Health Sciences, University of Nottingham Medical School tony.avery{at}nottingham.ac.uk