Friday, 4 March 2011

Warning! Stupid Sick People

Oh, Give me strength.

Research conducted by the BNF (British National Formulary) has found that the labels on medications are "too difficult for members of the public to understand."

Apparently phrases like "May cause Drowsiness" need to be replaced with "This medicine may make you sleepy" and "Avoid Alcohol" needs to now read "Do not drink Alcohol when taking this medicine"

Cue much re-writing of labels and leaflets, costing a fortune and achieving what exactly?

The last time I was discharged from hospital :

-My anti-emetic was prescribed as tablets instead of injections
-Another anti-emetic was dispensed in 25mg injections, but no-one told me I was only supposed to draw up a quarter of it and throw the rest away.
-I was only sent home with 38 pethidine injections despite it clearly saying 56 on the discharge request
-The pethidine injections were 50mg instead of my usual 100mg, meaning that I only had enough painkillers to last me until 3am on the Sunday morning after discharge, leaving me without until my surgery opened on the Monday and a new prescription could be arranged.
-The bottle of medazolam prescribed was missing altogether
-I was sent home with not one but two boxes of Tramadol - a painkiller I never take and which I am allergic to.
-I was sent home haemorrhaging because a blood thinning drug (Clexane) had been combined with an anti-emetic that caused bleeding. Despite trying to tell the staff for over 24 hours, no-one looked into it or asked if it had stopped before sending me home.

Recently, as part of the 20 Billion in "efficiency savings" the NHS are being ordered to make, my mother received a call from her doctor asking why she takes a more expensive antacid than the normal one prescribed. She explained that the cheaper alternative had given her an allergic reaction. (Something clearly detailed in her notes, had he read them.) Next, he mentioned that she'd had a TIA (mini stroke) "But I haven't?" She replied
"Do you know what a TIA is? He asked
"Yes, a Trans Ischemic Attack or mini stroke" she replied "I can assure you I've never had one."
"Oh! You must have been a receptionist!" Was his explanation for her knowing such a thing. Not a neurosurgeon or a physiotherapist, but a receptionist.

Here's an idea - why don't we stop treating patient's like idiots? After all, despite their assumptions we are able to decipher their endless mistakes and oversights in order to keep ourselves alive, so we might actually be capable of understanding the word drowsy!

Maybe - just maybe - it might improve things more if we stop asking harassed junior doctors to write up discharge meds when they've never met or treated the patient in question? Maybe, it might be a good idea to overhaul the system of ordering and dispensing pharmacy meds from hospital? While we're at it, that might have the accidental effect of ensuring it doesn't take all day long to get them up to a ward, freeing up beds for incoming patients? Maybe we should try really hard to actually prescribe the drugs the patient takes with the right doses and instructions?

Surely my suggestions would save a lot more lives than assuming that most patients have an IQ of 6?


  1. One of my medications lists the various side effects and ends like this "... paralysis, death. If you show any of these side effects consult your gp" haha

  2. my local hospital pharmacy refused to prescribe me the required 112 tablets and instead prescribed only 100 - because they come in boxes of 100 and they are not allowed to split boxes.


  3. Irecently went to the dentist and he would not record my medications and insisted I bring them in next time so he could log them on his files. This is depsite the fact I have been taking them for four years.

    Now, I have a degree, a masters and I am a qualified psychologist, a qualified teacher and a certified psychotherapist - I think I can remember what drugs I take.

    When will staff in the NHS trust their patients?

    Read my blog at

  4. Thought you might not have seen this little extra bit from the awful Grant Shaps .... perhaps a bit of acknowledgement of trying to stave of the appalling news headlines which are going to start coming.

  5. The approach to discharge medication appears to vary dramatically between hospitals. In my local, very large, general hospital each patient's meds are locked into a section of their bedside locker. A pharmacist or technician checks that the meds correspond with their chart at least once a day and orders further meds accordingly so that on discharge there is approx 4 weeks worth in each patient's locker. It works pretty well except when meds are changed simultaneously with discharge, and then there can be an hour's delay. But generally it works brilliantly.

  6. I must agree with Mark. Not all trusts are bad at discharging patients with the correct meds. Where I work, patients have lockers for meds and are encouraged to self medicate if at all possible (obviously not the case in the ICU.) The majority of discharges seem to go ahead as planned. Problems arise if patients are either moved due to bed shortages or are discharged for the same reason at short notice. On the whole I would say the system works well.
    As for simplifying the labels...with levels of education in this country being pretty poor, the average reading age is apparently only 8, (according to recent meetings I have been in regarding research applications in the trust) hence any information sheets that we give to relatives/patients regarding studies is written with this in mind. Working in ED I often heard patients commenting that they had no idea what tablets they took or even why they took them. Many do not bother to read the info sheets inside the packets. This is a concern as many meds are dangerous if not taken correctly.
    Finally, the comments about misdispensed meds. Two possibilities, either the doc prescribed it wrong or pharmacy dispensed it incorrectly. Most trusts that I have worked in, once meds are received from pharmacy you get a copy of the drug chart to check them against. If they match the chart and are still wrong then its a prescribing error and not pharmacies fault. I agree that junior docs are often trying to disharge patients that they do not know, hence the importance of checking the notes and the current drug chart to see what is being taken, as well as checking with the patient when they do the discharge summary (as they are taught to). Often this doesn't happen as they have too many patients and not enough hours in the day. Gone are the days when a firm had several HO and SHO...nowadays firms share F1 and F2 docs to cut down on costs.

  7. Tried to leave a comment agreeing with Mark but it seems to have vanished into the ether.

  8. Found your comment Dino.
    Incidentally, do you always disagree with everything I write intentionally? Lol

    No CDs will be kept in a locker or SAMd will they?
    Nurse Anne writes regularly about the nightmare of pharmacy, so I don't think It's just my life that has been dogged by incompetence for years.
    Yes, they come up with a discharge sheet, but how often does the nurse go through everything to make sure they tally? They've barely got time to save lives, never mind that.
    Yes, the mistakes are often due to doctors rushing and writing up the wrong thing, but I don't think I've EVER been discharged with exactly what was on my drug chart.

  9. I'm actually on your side Dino, not criticising for the sake of it. If you think everything in the garden is rosy (I know you don't) then fine, but patient's CAN have valid views too you know!! That's why I bother writing here at all. Perhaps if we listened to the patients AT ALL we might improve things.
    I want to make life better for patients AND nurses - it's not a war, though on a ward it can often feel that way. It's not "them and us" it's a system that serves neither, surely?

  10. lol your blog post made me and my husband laugh! its fantasic! such a great and informative post with humour! I've found that dispite having a university degree most doctors are stupid especially hospital doctors! Thankfully I have an intelligent, straight talking honest doctor! wished he was a neuro too!

  11. Once again another one of your posts which frankly would make better reading than the mush punted out to the public in the daily papers!

    It made me laugh but its not funny in reality.

  12. One of my regular readers left a link to here at my place mainly because we both posted on the same subject yesterday.

    Some interesting comments and I'm shocked, but not surprised, to hear Dino-nurse mention the average reading age is 8. Is that not a reason for every parent in the country to be up in arms? Oh silly me, the figure will include parents.

  13. Had a whole comment and lost the whole thing - argh!

    Subrosa if you had ANY idea what a nightmare it is to fight the system as a parent...good grief, I've been doing it for years but after a while it really wears one down. Now having to get an advocate to do it for me as I just don't have the energy.

    I have noticed in the UK and in other places that there is a definite culture of blind trust; people trust doctors implicitly as being infallible, and some doctors actually encourage such behaviour. I know of people who refuse to go to doctors for ailments because they "don't want bad news" and when they go in for biopsies, they don't even want to know results or treatment. Willful denial. So it honestly doesn't surprise me there are people out there who take pills without even asking themselves whether or not they should be taking them with other pills. I'm certainly aware that my GP isn't aware of all the meds the night doctor or the rheumy has given me (locum is on leave for a month and it almost seems pointless to get a GP who has never seen me get involved in all that - I usually get a 'ask a pharmacist' response). It seems sensible that medications for the chronically ill be reviewed regularly as I'm almost certain both doctors and patients forget what they're taking after a while and surely taking a dozen pills a day is not helping one's liver any!

  14. I'm not. Just trying to point out that not all trusts are the same. Most of the nurses I know would be horrified that patients are going home with the wrong meds. In my trust the pharmacy techs also go through meds with patients who are "self medicating" whilst on the ward. As for CDs this will always be tricky...the legal requirements are that they are kept in a cupboard within a cupboard and are checked by two people. At the moment that means two nurses. Personally I'm not sure I would be happy if this were changed, unless the legal requirements in hospitlas meant that if CDs went missing that nurses would not get the blame. I'm not saying that patients would do this deliberately but if a tablet were dropped for example, it would need to be documented somewhere and techs check CDs on a weekly basis and any errors are taken very seriously.
    I know that all is not rosy in the NHS and I have worked in a variety of other systems across the world- some better, some worse but all had their own problems. Staffing levels in US county hospitals were worse than in the UK for example. In general I would have to say that the Germans have the right system for most things and if we were sensible we would follow them

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  16. Dino Nurse - no the doctor did not misprescribe. I telephoned the pharmacy to ask what had happened and was informed that since the meds were expensive, they had to be rounded DOWN to the nearest boxful. When I asked why they didn't add a few extra tablets from another box I was told that this wasn't allowed.

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  18. Personally I'm not sure I would be happy if this were changed, unless the legal requirements in hospitlas meant that if CDs went missing that nurses would not get the blame. increase sex drive