FROM THE PRESIDENT

S E P T E M B E R 2 0 2 2

DR ANNA STAVDAL

W O N C A P R E S I D E N T

PATIENT SAFETY DAY, 2022 : SAFE MEDICATION!

Yes. Sixty years of studies have validated, repeatedly, that the doctor-patient relationship is a key to the placebo factor – how patients get well. It may represent as much as 30-40% of healing therapeutic responses, regardless of which medical personnel are involved, and including when medication is part of the treatment. But make no mistake about it: In our field, the prescriptionpadisoneverypowerfultool!

That’s why we at WONCA are so supportive of the selection of “Safe Medication!” as the theme of thisyear’sannualWHO“PatientSafetyDay” .

We Family Doctors must consider each aspect our Hippocratic Oath in every clinical decision we make: “Preferably cure, often alleviate, always comfort. But, first of all: Do no harm. ” Among our more difficult choices to balance are medications: prescribing them for patients, following up on their effects and side-effects, and making decisionsaboutceasingtoprescribethem.

A bit of background: Launched in 2019 by WHO, the17thofSeptembereachyearisnowtheglobal “Public Health Day” . Their emphasis is on solidarity and strengthening concerted action worldwide, both among countries and international partners. As the quality of care and patient safety are core themes in the Family Doctors’professionaldevelopment,it’snatural that WONCA’s Working Party on Quality and Patient Safety has forged such strong links to the WHO Department of Patient Safety in Geneva. We can thank them for leading the way in WONCA` s effortstocontributetothisglobalcampaign. I recommend that all WONCA members explore what contributions Family Doctors can make toward meeting the four objectives that the WHO has set for “Patient Safety Day, 2022 : Safe Medication! (Just so you know, WONCA’s Secretariat has created a toolkit for addressing theseaims.):

What is the drug you use with patients all the time? The doctor is the drug. Dr. Michael Balint

Objective1:RAISEglobalawarenessofthehigh burden of medication-related harm due to medication errors and unsafe practices, and ADVOCATE urgent action to improve medicationsafety.

We can look more closely at how we get our information about the medications we choose among, including how prescription guidelines have been devised, how specific they are about their treatment applicability, including within different fields and contexts. The pharmaceutical industryiscentralhere.

Obviously, they also play a major economic role. Funding is crucial to developing new treatments, carrying out research, and distributing research results. But: revenue is a primary goal for Big Pharma. If we’re to be trusted, we physicians at the prescribing end of the process need to help each other catch on to marketing ploys – before we fall for them. We must also sharpen our skills at interpreting research results to protect our patients from harmful drug interactions as well as other potentially negative effects, such as becoming over-medicated. This requires us to trust our clinical experience, especially the individualized knowledge we gather about our patients thanks to the relationships that our commitment to continuity of care helps us build. Results from randomized controlled trials are not necessarilyapplicabletothepatientinfrontofus!

Objective 2: ENGAGE key stakeholders and partners in the efforts to prevent medication errorsandreducemedication-relatedharm.

Family Doctors work at the community level where they engage with other professionals in Primary Care teams. Important assistance is provided by nurses, community health workers, pharmacists, among others, in the administering ofmedication,notleasttoelderlypeopleexposed to polypharmacy. Secondary Care hospital servicesalsoprescribemedication.Whenpatients return to their usual environment, be it their home or a nursing facility, the medications initiated during Secondary Care hospital treatments will need to be reevaluated. It serves the Family Doctor well to have established good collaborative relationships with their hospital and community co-workers. An example is when taking a patient off a specific medication that is no longer appropriate. Deprescribing turns out to be much harder than prescribing, often requiring genuine clinical courage. It is far less daunting to make and carry through on such difficult decisions when they’ve been arrived at on the basisofmutualprofessionalassessment.

Objective 3: EMPOWER patients and families to be actively involved in the safe use of medication.

This aim invokes the person-centered nature of Family Medicine. Recommending that someone take a medication every day is actually quite a radical intervention. Patient compliance –whether or not a patient follows our advice –depends also on us. Has the information we’ve communicated been sufficient, and tailored to that specific person right now? Have we made clear what positive effects we expect, as well as potential side effects? Have we also informed the patient what risks – and/or benefits – that might result from not taking the medication? Our patients need to experience that we evaluate each prescription carefully, and trust that we will reassess regularly whether – or not – the medicationcontinuestobeusefulforthem.

Objective 4: SCALE UP implementation of the WHO Global Patient Safety Challenge: MedicationWithoutHarm.

'Better Living Through Chemistry’ was an

American advertising slogan the DuPont chemical company came up with in the 1930’s. I’m told it was embraced as a rallying cry for mindexpanding drugs during the cultural upheavals of the ‘60’s and ‘70’s. Yet, from penicillin, to the smallpox vaccine, to stopping the scourge of polio, to slowing deaths by COVID, etc., it has provedprophetic. Tread carefully, however. We’re all aware of the doctor-assisted opiate addiction epidemic, and the burgeoning crisis of antibiotic-resistance after decades of over-prescribing, and, of course, there’stheanti-vaxxdistrust. We have our work cut out for us to achieve an honest mix: pharmaceuticals in service of our doctor-patientrelationships.Nottheopposite!

DR ANNA STAVDAL

W O N C A P R E S I D E N T

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