Creating a culture of thoughtful prescribing

Abstract

Background: In the Netherlands 170,000 patients yearly fall victim to poor communication between health care professionals, with 44% of patients receiving inappropriate therapy as a result. Evidence indicates that this problem may be due to physicians learning to communicate therapeutic content by unstructured means during training.Aim: To introduce a structured format for creating and communicating therapeutic plans; to provide for students opportunities practice and feedback on their abilities.Methods: We developed the Individualized Therapy Evaluation and Plan (ITEP) for therapeutic decision-making and communication based on the subjective objective assessment and plan note. The therapeutic plans from students of the 2003 cohort were assessed with one simple and one complex case using a 15-point criteria form. Over the next 3 years students were given more practice using the ITEP and the average score on the complex case was tracked and compared to the 2003 cohort.Results: In cohort 2003, 82% of the students satisfactorily completed the simple case, while only 32% did so with the complex case. In subsequent years, the average scores on the complex case significantly improved from 3.8 to 6.8 with increasing practice.Conclusions: Students can select a simple drug regimen, but without practice using the ITEP will not help to deal with multiple disease states.