"While the system detected a number of medication-related problems, it missed more than half of adverse drug reactions and two-thirds of episodes of non-adherence in patients—and would likely have done worse outside the controlled environment of a research setting."
Steinman wrote that one-fourth of adverse drug reactions can be prevented by catching errors or problems at the time of prescribing. And that most of the rest "are not the result of prescriber error but simply represent the known adverse effects of drugs," and physicians "cannot predict who will develop an adverse drug reaction and who will not."
The problem is, he says, that "physicians do not do a good job of identifying and appropriately managing adverse reactions when they occur," in part because many patients don't tell their physicians when they're experiencing one.
Sometimes, he added, doctors "misattribute the symptoms of an adverse drug reaction to an underlying disease, leading to diagnostic workups and a prescribing cascade of new medications rather than treating the problem at its source by discontinuing the offending drug."
What is needed, Steinman wrote, are proven coaching methods that help patients "be engaged participants in their own care," monitoring their own adverse reactions and non-adherence.
"The solution to the problems of adverse drug reactions and non-adherence cannot solely rest on bringing the healthcare system closer to the patient," he wrote. "We need to empower our patients to come closer to us."