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Editor,—Rowe and colleagues1 focus welcome attention on how the risk of neonatal unit prescribing errors might be reduced. Their suggestion that a simple test of mathematical ability may be able to detect individuals with impaired calculation skills deserves further evaluation. Some have gone further, proposing that a demonstration of mathematical ability should be a prerequisite for full registration with the General Medical Council.2This comment followed an inquest into the death of a premature newborn infant overdosed with morphine as a result of a 100-fold error. Currently all potential medical students are required to have GCSE mathematics but many go beyond this level. For example, among 149 entrants to Leeds medical school in 1996 two thirds had passed A level mathematics, 79% with grade A and the rest with grade B. Conversely, this means that one third had abandoned mathematics several years before starting medical studies. Whether school attainment in maths is later reflected in competence at calculations as a junior doctor was not explored by Rowe et al, but would be of interest.
A systems analysis approach to medication errors emphasises the need to examine mistakes in a broad context and thereby make it much harder for repeat mistakes to occur, recognising that the incident is often the end result of a chain of events set in motion by faulty system design. This approach has been conceptualised as a “search for the third order ‘why?’.”3 Why did the incident occur? Why did the error occur? Why did the apparent reasons for the error occur? Perhaps part of the faulty system is an unwarranted assumption by senior doctors with regard to the mathematical competence of their junior colleagues. It is possible that “the error” occurred because of failure to include some deliberate element of training in the type of calculation routinely required on the intensive care unit or paediatric ward, as advocated by Rowe et al.
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