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Resident Pathogens

Posted by Dr No on 04 December 2009

fingers.jpg“At that moment in time, a human error occurred…” intoned Count Rubin on yesterday’s Today programme. Uttered as it was with an air of omniscient mastery, it seemed some great catastrophe, like a jumbo jet crash, had occurred. The truth turned out to be rather more commonplace: a study had revealed that nearly one in ten prescriptions written by hospital doctors had been found to be wrong.

The Count was on the radio to explain that it wasn’t the GMC’s fault that the doctors were so bad at writing prescriptions. He didn’t actually go so far as to say it wasn’t the GMC’s fault, because that would have had everyone wondering whether it was after all the GMC’s fault. Instead, he just said it was somebody else’s fault. Or it was the systems’ fault. Just so long as nobody got to think: was it the GMC’s fault?

Mesmerised by the Count’s dulcet tones, Sarah Montague was rendered briefly silent. When she did recover, it was evident that the Count had had his way with her, for she had lost all sense of purpose or perspective. She even lost her facts, saying that two in a thousand of the errors were potentially fatal (the actual figure in the report is two in a hundred) but the Count, naturally enough, was happy with the lower figure, and told her it was correct.

The question Ms Montague should have asked the Count was of course: who is responsible for standards in medical undergraduate and first year doctor training? The answer is the GMC. On their website it says:

The GMC sets the standards and outcomes for basic medical education in the UK. This covers undergraduate education and the first year of training after graduation.

The GMC has in fact been meddling with medical undergraduate education for some time, chiefly by shifting the syllabus away from useful medical subjects like anatomy and practical therapeutics – which includes prescribing – to softer subjects such as diversity and the history of the NHS.

As a result, some three years ago, NICE chairman Sir Mike Rawlins went on the record, blaming the GMC for failing to make sure that young doctors were adequately trained to prescribe safely.

The GMC refuted the claim, but it lacked hard evidence to support it’s position. And so, quietly, it commissioned research to “explore the causes of prescribing errors made by FY1 doctors (first year foundation trainees), concentrating on the interplay between doctors’ educational backgrounds and factors in the practice environment”.

Now, commissioned research is a funny thing. More often than not, there is an element of “he who pays the piper calls the tune”, often exercised subtly, both by what question is asked, and by the way in which the question is phrased.

Note how, in the above research brief, it avoids the real question (are newly qualified doctors able to prescribe safely?); instead, the research is required to concentrate “on the interplay between doctors’ educational backgrounds” – a woolly term “ and factors in the practice environment” – a much clearer, more focused term. The result, inevitably, is to direct the research towards the clearer, more focused term.

The final report – which runs to well over two hundred pages – was completed last month, and it makes for an interesting read. Apart from introducing Dr No to some wonderful new jargon – the best being “resident pathogens”, “skill based slips” and “just-in-time training”, it also shows – unsurprisingly – that foundation year doctors do make the most mistakes (9.1% of all prescriptions) and consultants the least (5.9%).

To Dr No, those figures strongly suggest that junior doctors are inadequately trained to prescribe safely. Given that the GMC sets the standards for their undergraduate and first year training, it seems inescapable that the finger must now point at that biggest resident pathogen of all, the General Medical Council.

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