Intended for healthcare professionals


A prescription for better prescribing

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:459

Foundation Programme Doctors confirm that they are unprepared for safe and rational prescribing.

In their recent article in the BMJ (1), Aronson, Henderson, Webb and
Rawlins highlight the issues of poor medical prescribing, which has
resulted in a largely avoidable increase in patient morbidity and
mortality. The authors say that the reasons for these errors are manifold;
however a lack of undergraduate teaching in Clinical Pharmacology and
Therapeutics must take a significant share of the blame.

We recently
conducted a prospective questionnaire survey of the views of foundation
programme doctors (FY 1) coming towards the end of their first year in
training. The questionnaire sought to determine whether, in retrospect,
they believed that their undergraduate education in Clinical Pharmacology
and Therapeutics had prepared them to prescribe safely and rationally.

Ninety FY1 doctors were surveyed and 71% completed the survey. 30% of
respondents rated their knowledge of CPT as poor or worse and only 8% as
good. Almost half of respondents (41%) believed that their undergraduate
training had not equipped them to prescribe rationally or safely, and more
than a third reported encountering specific prescribing problems such as
special patient groups, drug errors, and drug toxicity during routine
work. Three-quarters (74%) reported witnessing an adverse drug reaction,
and 55% a drug-drug interaction, many of which although avoidable had
resulted in patient morbidity or mortality. 60% of respondents stated that
they had not been taught in sufficient detail about how to avoid ADRs, or
drug-drug interactions during their undergraduate years, and more than
half (56%) about prescribing and ensuring patient safety during their
postgraduate year. Over 75% of respondents reported inappropriately high
levels of confidence for the unsupervised use of drugs including warfarin,
non-steroidal-analgesics, opiate analgesics, and sleeping pills,
suggesting that prescribing confidence develops from familiarity rather
than a true appreciation of risk. When asked in retrospect which topics
required more extensive coverage, FY1 doctors favoured prescribing for
special patient groups, drug-drug interactions, adverse drug reactions,
and therapeutic drug monitoring during the undergraduate years with more
practical based teaching of clinical pharmacology and therapeutics focused
on ensuring patient safety, and day-to-day prescribing /therapeutic issues
during the postgraduate years.

It is evident that junior doctors, 1 year into their careers, are in
agreement with the authors of the BMJ editorial “A prescription for better
prescribing” recognising significant deficiencies in their ability to
prescribe rationally and safely, and the need for an increase in
undergraduate and postgraduate training in practical drug therapy and

1: Aronson JK, Henderson G, Webb DJ, Rawlins MD. A prescription for
better prescribing. BMJ. 2006; 333:459.

Competing interests:
None declared

Competing interests: No competing interests

27 September 2006
James S McLay
Senior Lecturer
Mansour Tobaiqy, Sarah Ross
The Department of Medicine and Therapeutics. The. University of Aberdeen. AB25 2ZD