Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

To err is human... prescribing errors in cancer treatment (#22)

Dorothy M Keefe 1
  1. University of Adelaide, Adelaide, SA, Australia

Systemic cancer therapies, including chemotherapy, targeted agents and immunotherapy, are in very common and rapidly increasing use across Australia. They have changed the outlook for cancer patients over the past 50 years from a much-feared death sentence to, perhaps, a life sentence and even a cure in many cases. However, they are not without their problems and as usage increases and changes, the safety systems we have put in place become stretched and outgrown. Errors do occur – and tend to be widely reported. Public perception of and interaction with the health system has also changed, and social media and the internet have brought much joy but also new challenges for health professionals.

We are supposed to live in a ‘no blame’ culture, but Australian health systems are not very good at the ‘no blame’ part of this. Egged on by social media commentary and the rise of populism, somebody must be blamed for every bad outcome (whether the result of an error or not) and then named, shamed and publically punished. This results not in learning from our mistakes and using this learning to improve our systems, but rather in a culture of fear (particularly of litigation and loss of reputation), a “them and us” mentality, and loss of trust between clinicians and patients.

There are increasing areas where collisions between the professions and the community are almost inevitable. For example, the patient’s right to choose alternative treatment rather than proven therapies; patients’ expectation that doctors know exactly how to cure their cancer versus clinical reality and uncertainty; the balance of efficacy and toxicity of treatment; whose fault it is if treatment doesn’t work or is toxic; protocol-driven prescribing versus clinical autonomy - and the expectation of cure when cure is not possible, to name just a few.

Electronic chemotherapy prescribing systems are only as good as the Governance systems that are put around them, but they can and should take some of the risk out of prescribing what are potentially dangerous drugs. I see them as something that can help protect me from the errors I might otherwise make; others see them as restricting their clinical freedom.

Much work is needed to improve our systems and culture to enable clinicians to practice without fear, to keep up to date with the latest evidence for treatments, and to communicate more openly and successfully with the patients we are trying to help.