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
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.
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.
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.
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.
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.