American College of Physicians: Internal Medicine — Doctors for Adults ®

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Don't forget to tap a major safety resource: your patients

From the June ACP Observer, copyright © 2003 by the American College of Physicians.

By Bonnie Darves

SAN DIEGO—As efforts to improve patient safety continue to heat up, many physicians overlook a major safety-improvement resource: their own patients.

The need to boost patients' vigilance against potential errors is particularly critical in ambulatory settings, where poor communication "is a major cause of 'latent errors,'" said Robert C. Gong, ACP Member, who gave a presentation at Annual Session on patients' role in patient safety.

As an example of how latent errors occur, Dr. Gong said that studies have estimated that one-third of patients don't understand what their doctors tell them to do.

The results can be catastrophic. Dr. Gong cited the example of a patient who, during a follow-up visit for psoriasis, was given prescriptions for two creams: one for the face and one for the body. During the visit, the doctor discussed the difference between the two medications, but he wrote only "use as directed" on the prescriptions.

The patient used the creams incorrectly, putting the wrong lotion on his face for several weeks. By the time the error was discovered, the patient had already incurred scarring.


Dr. Gong says that patients can be a valuable tool when it comes to avoiding errors.


Had the patient been more direct about making sure he understood the difference between the medications—by asking the pharmacist for detailed instructions, for example, or by calling the physician when he first began experiencing problems—the adverse outcome might have been prevented.

"We need to educate our patients to take that proactive role and call us," said Dr. Gong, an internist with Siena Hills Primary Care in Henderson, Nev. "Error prevention doesn't have to involve a lot of high-tech areas, but rather a lot of mundane tasks that we do every day."

Some patients are already active "directors" of their own care and can pick up on potential errors, he said. Other patients, however, are passive "receivers" of information their physicians deliver.

You have to educate them to verify medication prescriptions and doses, voice concerns about their health or your treatments, and double check your recommendations before they leave the exam room.

Dr. Gong also said patients can do more to ensure their own safety by taking the following steps:

  • Provide complete information about the medications they're taking, including over-the-counter and herbal preparations.

  • Remind their physician of any allergies and adverse reactions they've had to medications in the past.

  • Make sure they read the prescription before taking it to the pharmacy.

  • Ask for complete information about medications and potential side effects in terms they can understand.

Dr. Gong also urged physicians to work to dispel the "no news is good news" myth when it comes to test results. Because some test results ends up in the wrong charts, he said, patients need to understand that they should always ask about results if they haven't received verbal or written notification of tests and other procedures.

Bonnie Darves is a freelance writer in Lake Oswego, Ore.

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How to report errors and near misses

You can report medication errors in confidence to the medication errors reporting program operated jointly by the United States Pharmacopeia and the Institute for Safe Medication Practices. To phone in a report (you can do so anonymously), call 1-800-23-ERROR.

Both organizations review all reports. They also share the reports' contents with the FDA and the manufacturers of medications that have been involved in prescription errors or "near misses."

The USP and ISMP Web sites, along with the new patient-safety section on ACP's Web site, also give physicians tips and resources on reducing prescribing errors.

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