Survey examines intimidation by prescribers

Nurses and pharmacists are frequent targets of intimidation by physicians, which has led to medication errors, according to health care professionals who responded to a survey by the Institute for Safe Medication Practices.

Almost half of the more than 2,000 respondents said intimidation has altered how they handle concerns about medication orders. Also, 69% said that at least once a year, physicians have replied to their questions by saying "Just give what I ordered," and 7% said that they were involved in a medication error during the past year in which intimidation clearly played a role, the ISMP survey said.

"The problem is probably even more prominent than the report shows," said ISMP Medical Director Russell Jenkins, MD, who added that the hurry-up mode of today's health care environment leads to interactions in which a doctor may engage in intimidation without realizing it.

"We're taking care of sicker, older people with much more potent medications and we have to do it much faster," said Dr. Jenkins, who admitted he was guilty of intimidating behavior himself before retiring from his post as director of respiratory therapy at St. Luke's Quakertown Hospital in Quakertown, Pa. "I would become quiet and wouldn't respond immediately to a question. I was fortunate to have a wife who was a nurse who would remind me of things I did that were not appropriate."

Doubts about the survey, however, were raised by University of Michigan Health Systems Chief of Clinical Affairs Darrell Campbell, MD.

"I think the survey reflects the past culture, and the new culture of patient safety is trying to change that and let people speak out if that's what it takes to protect the patient," said Dr. Campbell, who has declared his intention to make the U of M Medical Center in Ann Arbor the nation's safest hospital.

ISMP President Michael Cohen said the survey, responded to by 1,565 nurses, 354 pharmacists and 176 others, was "more of a straw poll than a scientific study," but "it's still a reflection of what is going on out there in the real world."