Intended for healthcare professionals


When ignorance is not bliss

BMJ 2003; 327 doi: (Published 09 October 2003) Cite this as: BMJ 2003;327:877

How to reduce medical mishaps

Dear Sir

I read with great interest the article on the Personal View column by
.Ms Wendy Jones (BMJ 2003:327:877).

As a Rheumatologist with many years’ experience, prescribing many
potentially toxic medications, I am sure, like myself, all
Rheumatologists, and lately also Specialist Nurses, are always informing
patients and reminding them of the potential adverse effects of drugs and
the need for regular monitoring. This is especially important in patients
who are on disease modifying drugs. Despite this, as indicated by Ms
Jones, there are occasions when drugs are not taken appropriately and
patients do end up in some peril, at times unfortunately with tragic
results, as indeed, in the case of Methotrexate recently.

It is routine practice in clinics to provide information leaflets
regarding medications and, of course, as commented by the author , there
are lapse occasionally in this good practice also. It is clinicians’
experience, however, that sometimes patients do not take in the
information provided and hence the need for provision of printed
information materials.

To avoid such mishaps, it has been my own practice(Clinician in
Management 2001;10:203-7) to copy General Practitioner's letters to the
patients where some pertinent details are generally given with regard to
diagnosis, medications and the potential adverse effects, and the need for
monitoring. This reiterates advice given at the clinic verbally and
patients also have some printed material to refer to, to remind them what
has been said at the clinic. It is to be noted that such copying of
letters to patients will become law shortly.

Another way that I tackle potential problems is to get the services
of what I have termed as "patient carers" (Clinician in Management 2001;
10:203-7). "Patient carers" are themselves patients who have had chronic
rheumatological illnesses such as rheumatoid arthritis and these people
have been trained in my own clinic with the Trust approval. I believe
that as patients they can empathise with other patients. Often it is
easier for patients to relate to other patients, get helpful information
regarding their diagnoses and proposed treatment (including surgery), and
where newly diagnosed patients are concerned this service is especially

This "Patient Carer" project has been successful in my experience
here over the last few years and I am pleased to note that the NHS is
advocating now what is called "expert patients". .Indeed, we are beginning
to contribute to the National Rheumatoid Arthritis Society programme on
expert patient network throughout the country, soon to be launched. This
will be another way to address some of the problems and issues raised by
Ms Jones..

Finally, use of new IT may help in this regard. For example, I have
improved access to my patients through e-mail (BMJ 1999;318:1428) and text
messaging (BMJ 2003;326:607) contacts directly with myself, to raise any
queries or concerns, including adverse effects of medications, so that
they receive prompt response with advice, rather than having to wait for
weeks in the conventional routes of communication.

One further way that we are trying to exploit the inexpensive text
messaging facilities, is that of using bulk texting through software that
we have developed ourselves, so that secretaries are able, via their PCs
, to send text messages to patients to remind them of their forthcoming
clinic attendance. We are currently also exploring ways of using the same
technique to remind patients of their need for monitoring, for example,
blood tests, to further safe-guard their continued use of the disease
modifying drugs.

Yours sincerely

Dr B Pal

Consultant Rheumatologist

Competing interests:
None declared

Competing interests: No competing interests

20 October 2003
Badal Pal
Consultant Rheumatologist
Withington Hospital, M20 2LR