"Educate Before You Medicate"
is Resounding Take-Away Message
Following Medical Errors Report

Medical errors, including those caused by medications, may fall into the country's top 10 leading causes of death, according to an Institute of Medicine (IOM) report issued Nov. 29. Deaths from medication errors exceed those from workplace injuries, the IOM found. Overall, deaths from medical errors range from 44,000 to almost 100,000, ranking closely behind U.S. deaths from heart disease, cancer, stroke, and lung disease.

Since 1982, NCPIE has focused public and health care professional attention on improving appropriate use of medicines. The message of safe medicine use is integral to every "Talk About Prescriptions" Month observance sponsored by NCPIE and our members. To further promote our message to the public, in October 1999 NCPIE launched its website at www.talkaboutrx.org. We chose a domain name that would be memorable, simple and direct to our mission… with a message that speaks to the broad coalition that makes up the National Council.

Just weeks after the IOM report, NCPIE selected the theme, Educate Before You Medicate: Knowledge is the Best Medicine, for the October 2000 "Talk About Prescriptions" Month. The continuity with last year's message (Educate Before You Medicate), combined with the sensible tag line, Knowledge is the Best Medicine, should help to reassure - and empower - consumers after the media frenzy surrounding the IOM errors report. For nearly two decades, NCPIE has empowered consumers with questions to ask about their medicines, and has empowered health care professionals with tools to talk with their patients about appropriate medicine use.

For example, NCPIE offers the medication Wallet Card and the "TAP" poster, both of which feature questions for consumers to ask. For health care professionals, NCPIE has the National Medication Check-Up Kit. These resources are available for purchase from our website; members receive a 20% discount.

Other recent reports exploring patient-physician communication also support NCPIE's mission to improve communication about the appropriate use of medicines:

From American Medical News, Dec. 20, 1999: "You can't make patients take their medication," says Ronald Ferdman, M.D. (Children's Hospital of Los Angeles). "But we're the only ones who can convince patients and make them feel the importance of taking a medication."

The article continues: Communication is another major factor. Many patients simply do not understand their prescribed course of treatment. "We need to do a better job of communicating to patients why they're on this medicine and why they need to be taking it," says Jerome Avorn, M.D. (Harvard Medical School and Brigham and Women's Hospital, Boston). When physicians fail to warn patients about potential problems, patients often use those complications as a reason to quit taking the medicine, Avorn says.

Experts agree there is no substitute for a physician devoting a few personalized minutes to compliance issues. Otherwise, the rest of the physician intervention might be moot.

From the Journal of the American Medical Association, Dec. 22/29, 1999 (Braddock et. al.): Fully involving patients in clinical decisions is a challenging task for clinicians, and little training exists on the practice of effective informed decision making. An evaluation of over 1,000 audiotaped physician-patient discussions (among primary care physicians and surgeons) found that only 9% of the clinical decisions could be defined as truly informed decision making. The authors observed, "there are quality-of-care concerns, since there is mounting evidence that inadequate patient involvement may interfere with patient acceptance of treatment and adherence with medical regimens."

Braddock and his colleagues noted that most research emphasis on "informed consent" has addressed invasive procedures or participation as a research subject. "Turning attention to decision making in office practice reveals that this emphasis has not created a positive model of informed decision making that is relevant and achievable in clinical practice in which the majority of decisions are less than complex. Promotion of the patient's understanding, thereby fostering informed participation, is the essence of informed decision making."

In an accompanying editorial, Michael Barry, M.D., observes, "Most physicians would accept the importance of informed consent to patient management as something more than just a medical-legal necessity…. Physician time will be a major impediment, and new strategies, including more effective and efficient use of educational materials and decision aids in office practice, will need to be developed…. as part of the solution."

NCPIE recognizes that there are many external variables that influence physician-patient communication, including: health care system (operational) constraints, reimbursement policies, and timely access to information. NCPIE's efforts have historically focused on internal variables within the professional's (and patient's) control.

From JAMA, "Patient Page," Dec. 22/29, 1999, "How to Talk With Your Doctor" recommends that patients:

1. Write down any questions to discuss with your doctor;
2. Write down any symptoms or health concerns you have;
3. Tell your doctor about all the medications you take, including prescription and non-prescription medicines, vitamins, supplements;
4. Be completely honest about your lifestyle;
5. Inform your doctor about any cultural or religious beliefs that may affect a treatment option;
6. Make sure you understand your doctor's recommendations.

(For the JAMA "Patient Page" entitled "Take Your Medications as Prescribed," which includes NCPIE's list of questions to ask, see the July 21, 1999 JAMA.)

In sum, as medical errors grab the headlines, it is important to publicize simple - yet effective - steps each one of us can take to promote appropriate medicine use. Educate Before You Medicate: Knowledge is the Best Medicine could prove to be a lifesaving message.