A prescription for better prescribing

The final exams are over. The years of hard work at your United Kingdom medical school have paid off. You are ready to start foundation year 1. But a small anxiety emerges- are you prepared? In particular, are you properly trained in practical drug therapy and prescribing? We believe you may not be.

In July we drew attention, yet again, to what we and many others perceive to be a serious problem in British medicine-poor prescribing.12 We emphasised that deficiencies are not confined to the UK, and three days later the Institute of Medicine in the United States independently expressed similar concerns.3 The chairman of the medical academic staff committee of the British Medical Association later concurred,4 and the Healthcare Commission urged the NHS to improve prescribing.5

Evidence of poor prescribing in the UK is abundant. Effective treatments, such as angiotensin converting enzyme inhibitors for heart failure 6 and statins for hyperlipidaemia,7 are often under- prescribed. Prescription errors are common,8 especially when new doctors start work in hospitals.9 About 6.5% of admissions to hospital are related to adverse drug reactions, with an associated mortality of 0.15%; this costs the NHS £466m (€692m, $881m) annually.10