RCPE Press Release

19 January 2011

An international medical expert will today urge a step change in Scottish doctors’ approach to patient safety and warn doctors that they must learn to think more critically if wishing to reduce the number of adverse incidents in Scottish hospitals. He will also urge that medical schools in Scotland and internationally need to adapt their curricula in order to ensure that doctors of the future are better placed to make clinical decisions which can have serious adverse implications for patients if incorrect or not fully informed.

Prof Pat Croskerry, Nova Scotia, Canada, a leading international expert in patient safety and clinical decision-making, will be speaking at a conference in Edinburgh organised jointly by the Royal College of Physicians of Edinburgh, Scottish Intensive Care Society and NHS Quality Improvement Scotland [1] aimed at improving patient safety in Scotland. During his presentation Prof Croskerry will highlight that whilst patient safety has improved in recent decades as a result of the development of evidence-based medicine (in which doctors practise medicine based upon the best available scientific evidence), doctors are not thinking sufficiently critically to inform their clinical decision-making and ensure the best outcome for patients. In some cases, this could have serious consequences for patients including the risk of permanent disability or death.

Critical thinking is a learned process which benefits from teaching and includes conceptualisation, analysis and evaluation of information gathered from medical history or records or generated by physical examination or laboratory investigation.

Prof Pat Croskerry, Department of Emergency Medicine, Dalhousie University, Nova Scotia, Canada, said,

“Doctors are required to make clinical decisions on a daily basis which can literally have life or death implications for patients, not only in emergency situations but also in the daily routine of general practice. The development of evidence-based medicine has greatly helped to ensure that patients receive the most appropriate treatment based upon the available scientific evidence, but in so doing we have put less emphasis on the human element and this has been undervalued. By focussing solely on the available evidence, doctors can easily miss warning signs or indicators of more serious disease which can be learned through experience. They may also encounter the patient’s complications in an entirely different context or setting to that in the evidence and there is also an important need to take into account the patient’s individual circumstances, values and preferences.

“The key to improving clinical decision-making, and improving patient safety further, is to shift the emphasis in medical practice and teaching in order that doctors can be trained to not just assess the available evidence, but, of equal importance, to also reflect on their own thinking in their approach to dealing with clinical problems. In essence, it is now time for a further step change in our approach to patient safety which will combine the benefits of evidence-based medicine with critical thinking and well-calibrated decision-making. Effective critical thinking needs to be learned and greater prominence needs to be given to training doctors to think more critically in their early years at medical school and throughout their medical careers”.

In addition to Prof Croskerry, the event will feature presentations from a range of speakers providing updates in developments in patient safety, including Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, Olivia Giles MBE and Dr Ross Paterson, Scottish Patient Safety Programme.

Dr Graham Nimmo, Royal College of Physicians of Edinburgh, and a Consultant in Intensive Care Medicine, said,

“The safety of patients is of paramount importance and our first priority. It is for this reason that we have convened this conference in order to increase awareness amongst doctors and other healthcare staff in Scotland about the latest developments and international thinking in patient safety. It is recognised that there are many pressures on the system when patients are admitted to hospital and this can result in different forms of adverse incidents including drug errors, both in terms of prescribing and administration, and errors in diagnosis. When such incidents do occur they, understandably, dent public confidence and trust. As doctors, we are keen to ensure the quality and reliability of the healthcare provided and are continually developing safer systems in which we believe patients in Scotland can have confidence”.

Dr Brian Robson, Medical Director, NHS Quality Improvement Scotland, said,

“Scotland has developed an international reputation for its commitment to improving the quality and safety of care for patients. NHS Quality Improvement Scotland plays a key role in supporting these improvements involving changes from the bedside to the Boardroom through engaging professionals, patients, carers and the wider public. We are delighted to support the Royal College of Physicians of Edinburgh at this important conference which will explore how the reliability of healthcare can be even further improved. The conference yet again proves that Scotland punches above its weight in bringing international experts and Scottish clinicians together to share and learn together to improve our care and services for patients”.

Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, Scottish Government, said,

"International experts tell me that the safety work in Scotland's NHS is unique in the world.

"The collaboration of senior policy leaders, clinicians, managers and, most importantly, patients and families in the Scottish Patient Safety Programme has so far delivered unprecedented changes in Scotland's hospitals. This includes infection reductions, improved drug safety and mortality reductions.

"Patient safety is a top priority in NHS Scotland's Quality Strategy. Building on the groundbreaking work of the Scottish Patient Safety Programme we have recently launched the first country-wide paediatric safety programme and are moving into primary care and mental health.

"I am proud of the work being done to make care in Scotland's NHS even safer and I am delighted this conference will help share best practice."


Contact: Graeme McAlister on 0131-247-3693 or 07733-263453


[1] RCPE/SICS/NHS QIS Hot Topic Symposium on Patient Safety and Clinical Decision Making, 19 January 2011, 9.00am – 4.30pm, Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh.