Dr. C. Everett Koop's eventful tenure as U.S. Surgeon General from November 1981 to October 1989 greatly enhanced public awareness of a variety of pressing health concerns. Since his resignation as Surgeon General, Dr. Koop has continued to be a force for public health and health education through writings, electronic media, public appearances, and as Senior Scholar of the C. Everett Koop Institute at Dartmouth. Dr. Koop delivered the keynote address at the "Beyond Blame" presentation sponsored by Bridge Medical on December 9, 1997 during the ASHP meeting in Atlanta. Below is a summary of his remarks.

SUMMARY

Dr. Koop called on pharmacists, physicians, nurses, and other health care providers to join in an effort to implement systemic changes in the way medications are ordered, prepared, and delivered to patients in order to reduce medication errors and adverse drug events. His comments focused on three themes: trust, responsibility, and opportunity.

Dr. Koop stated that trust between patients and health care providers is the foundation of health care. He noted, however, that the public is becoming increasingly aware of the problem of medication errors and many people no longer trust health care institutions to hold the interests and safety of the patient above all else. The growing problem of medication errors and adverse drug events in hospitals, therefore, threatens not only patient safety but also the essential relationship of trust between patients and health care providers.

He acknowledged that in the current environment, with its economic pressures, hospital reorganizations, and fast-paced technological innovation, it is often a challenge for pharmacists, nurses, and physicians to spend the amount of time they would like to with their patients. However, he urged all health care providers to develop a relationship of trust with patients by establishing meaningful one-to-one communication with them and by enlisting them as partners in maintaining health and treating illness.

To be worthy of this trust, Dr. Koop emphasized that health care providers must live up to their primary responsibility which is to put the safety and welfare of the patient above all other considerations. He conceded that this often can be a challenge since pharmacists, doctors, and nurses also have significant and sometimes conflicting responsibilities to their employers, co-workers, and others. Such circumstances, he noted, frequently are related to economic issues. For example, people who manage health care entities may establish policies that are intended to reduce costs without having an understanding of their clinical implications. Consequently, clinicians may be asked to cut staff or services that they believe are needed to provide quality patient care. Dr. Koop stated that health care professionals who believe patient safety is being compromised in their institutions therefore have the additional responsibilities of educating senior management, explaining why a different approach to care is needed, and urging their colleagues and professional organizations to advocate patient interests.

Dr. Koop encouraged all health care providers to work together in an atmosphere of mutual respect to defend patient interests and improve patient outcomes. He emphasized that only through interdisciplinary cooperation and the willingness to look at new and better solutions can the complex system of delivering medication to patients be improved. In conclusion, Dr. Koop maintained that by implementing medication delivery systems that are designed to reduce medication errors and adverse drug events, health care providers will find new opportunities for their institutions, for they will have the tools needed to continually improve the quality of drug therapy and reduce costs.