From medical student to junior doctor: Clinical pharmacology to prescribing responsibility

Prescribing drugs is an important part of most doctors' work and begins suddenly on day one of the house officer year. Although pharmacology is a core component of the undergraduate curriculum, the processes of prescribing and its regulations and legal provisions are variably taught and supervised. Prescribing is one aspect of patient care where it is possible to do considerable harm.

Most junior doctors are unaware of the sizeable contribution prescribing aberrations make to hospital adverse reportable events and medicolegal activities. The incidence of drug related adverse events in patients in hospital varies widely—between 2% and 35%, depending on the rigour with which events are sought.12 The leading cause of medical injury in hospital practice is adverse drug events, about half of which are the result of errors.23 A study by a large insurer showed that injuries caused by drugs were the most common reason for procedure related malpractice claims.4

Although hospital pharmacists may do a chart audit, this should not be relied on—the prescriber has clinical and medicolegal responsibility. This article recommends simple assessment and prescribing guidelines.