Errors In Prescribing Medicine

"Mistake" in the medical world brings with it a number of technical and legal considerations. In the article, we will analyze the terminological nuances of the concept of "error".

In the context of growing attention on a series of interconnected issues, ranging from the right to health to the safety of care, from the improvement of the healthcare system to the troubled regime of professional liability, the issue of error in the prescription of drugs in the medical field has attracted increasing attention both in the media and in law.

That's the reason that many medical facilities organize prescribing skills assessment tests for their staff to reduce drug prescription errors. It is, therefore, appropriate to draw attention to this issue, starting with the conceptual profile.

Notions of error

By 'error' is meant, first of all, false knowledge: if, at 11 o'clock, a person believes that it is noon, this knowledge constitutes 'error'. By 'mistake' is also meant conduct with an improper result (i.e. conduct which is put in place for a particular purpose but, being technically unsuitable for that purpose, does not produce any result or produces a result different from that intended): if Titius, wishing to correct the time indicated by his watch, forces the crown by pressing it towards the case he makes an "error".

In order to better underline the two notions, it is possible to speak of gnoseological error in the first case, and of a technical error in the second case.

It is obvious that the two notions can be linked and that, in practice, the gnoseological error can be a causal factor of the technical error: in fact, consider that, when Titius forces the crown of the watch by pushing it towards the case, the technical error may depend on mistakenly believing that the crown becomes operative by pushing it towards the case.

This relationship is not, however, conceptually necessary: a subject, even if he knows very well the operational positions of the crown, may make that wrong gesture perhaps out of simple distraction (he is thinking of something else), or he may make it merely as a result of clumsy behavior.

Error in the medical field and in drug prescription

The error in the medical field presents itself in the typology already consolidated in common knowledge.

A typical case of a gnoseological error in the medical field is the diagnostic error: the referrer, in the presence of pathology A, does not recognize any pathology or sees pathology B. If, on the contrary, the surgeon, during an operation of eyebrow ptosis (lifting), by distraction or by excessive force applied to the instrument, damages the supraorbital nerve, it is a mistake of execution.

The link between gnoseological error and technical error

In the medical field, the link between gnoseological error and technical error is particularly evident: in fact, an incorrect diagnosis can lead to an incorrect prescription. However, an error of execution can also occur in the absence of a pre-existing or concomitant gnoseological error.

More specifically, the error in prescribing the drug is likely to be mainly due to a gnoseological error: in fact, the prescription may be wrong (useless or harmful drug) as a consequence of a diagnostic error; or, the prescription may be wrong because it is mistakenly believed that the alpha drug is suitable to treat pathology A.

On the other hand, the possibility cannot be ruled out that, at the root of a gnoseological error (regarding the efficacy of a drug), there is a technical error, in that, due to haste or incapacity, the doctor has not carried out the anamnesis correctly or has omitted technically necessary or at least appropriate investigations or research.

What is the relationship between error and inappropriateness?

On the one hand, it may continue to be held that inappropriate conduct is to be assessed, for the purposes of compensation, through the traditional notion of error. Thus: if inappropriateness implies an error (gnoseological or of execution) and if this error is attributable to negligence or inexperience, liability for unjust damage will ensue.

However, it is likely that the notion of inappropriateness will gradually supplant the notion of error, so that the latter will tend to be marginalized, especially in the field of medical liability.

Ultimately, it is possible that the notion of inappropriateness will constitute a further stage in that journey which, coming from afar, is oriented towards increasing the rights of the individual: a stage destined to constitute a new cultural, ideological and legal challenge ground in the difficult and dynamic balance between the rights of the individual and the protection of the professions.