E. Part of his explanation for the error was his willingness to capitulate when tired: `I did not ask for any medical history or something like that . . . over the telephone at three or four o’clock [in the morning] you simply say yes to anything’ pnas.1602641113 Interviewee 25. In spite of sharing these equivalent characteristics, there were some differences in error-producing conditions. With KBMs, doctors were conscious of their knowledge deficit in the time of the prescribing selection, unlike with RBMs, which led them to take one of two pathways: approach others for314 / 78:two / Br J Clin PharmacolLatent conditionsSteep hierarchical structures within health-related teams prevented physicians from looking for help or certainly receiving adequate aid, highlighting the significance from the prevailing medical culture. This varied between specialities and accessing tips from seniors appeared to be additional problematic for FY1 trainees functioning in surgical specialities. Interviewee 22, who worked on a surgical ward, described how, when he approached seniors for guidance to stop a KBM, he felt he was annoying them: `Q: What made you assume that you may be annoying them? A: Er, just because they’d say, you know, first words’d be like, “Hi. Yeah, what’s it?” you realize, “I’ve scrubbed.” That’ll be like, kind of, the introduction, it wouldn’t be, you understand, “Any complications?” or something like that . . . it just doesn’t sound very approachable or friendly on the telephone, you understand. They just sound rather direct and, and that they have been busy, I was inconveniencing them . . .’ Interviewee 22. Medical culture also influenced doctor’s behaviours as they acted in ways that they felt had been vital to be able to match in. When exploring doctors’ reasons for their KBMs they discussed how they had selected to not seek guidance or data for worry of seeking incompetent, specially when new to a ward. Interviewee 2 below explained why he didn’t verify the dose of an antibiotic despite his uncertainty: `I knew I should’ve looked it up cos I didn’t actually know it, but I, I feel I just convinced myself I knew it becauseExploring junior doctors’ prescribing mistakesI felt it was one thing that I should’ve recognized . . . since it is very easy to acquire caught up in, in becoming, you realize, “Oh I am a Physician now, I know stuff,” and using the stress of people today who’re perhaps, sort of, a little bit far more senior than you thinking “what’s wrong with him?” ‘ Interviewee two. This behaviour was described as subsiding with time, suggesting that it was their perception of culture that was the latent condition as opposed to the actual culture. This interviewee discussed how he ultimately learned that it was acceptable to verify details when prescribing: `. . . I uncover it really good when Consultants open the BNF up inside the ward rounds. And you consider, well I am not supposed to understand every single medication there’s, or the dose’ Interviewee 16. Health-related culture also played a role in RBMs, resulting from deference to seniority and unquestioningly following the (incorrect) orders of senior medical doctors or experienced nursing employees. An excellent instance of this was given by a medical doctor who felt relieved when a senior colleague came to help, but then prescribed an antibiotic to which the patient was allergic, despite getting already noted the allergy: `. journal.pone.0169185 . . the Registrar came, reviewed him and mentioned, “No, no we should really give Tazocin, penicillin.” And, erm, by that stage I’d forgotten that he was penicillin order KN-93 (phosphate) allergic and I just wrote it around the chart without the need of KN-93 (phosphate) site pondering. I say wi.E. Part of his explanation for the error was his willingness to capitulate when tired: `I did not ask for any medical history or something like that . . . more than the telephone at three or 4 o’clock [in the morning] you just say yes to anything’ pnas.1602641113 Interviewee 25. In spite of sharing these similar characteristics, there were some differences in error-producing situations. With KBMs, doctors were aware of their understanding deficit in the time with the prescribing decision, unlike with RBMs, which led them to take among two pathways: approach other people for314 / 78:two / Br J Clin PharmacolLatent conditionsSteep hierarchical structures within medical teams prevented medical doctors from in search of assistance or certainly getting sufficient assistance, highlighting the importance with the prevailing health-related culture. This varied between specialities and accessing assistance from seniors appeared to become additional problematic for FY1 trainees working in surgical specialities. Interviewee 22, who worked on a surgical ward, described how, when he approached seniors for assistance to prevent a KBM, he felt he was annoying them: `Q: What produced you think that you just might be annoying them? A: Er, just because they’d say, you understand, first words’d be like, “Hi. Yeah, what is it?” you understand, “I’ve scrubbed.” That’ll be like, kind of, the introduction, it would not be, you understand, “Any issues?” or anything like that . . . it just does not sound extremely approachable or friendly around the phone, you realize. They just sound rather direct and, and that they have been busy, I was inconveniencing them . . .’ Interviewee 22. Medical culture also influenced doctor’s behaviours as they acted in strategies that they felt have been important to be able to fit in. When exploring doctors’ causes for their KBMs they discussed how they had chosen not to seek suggestions or details for worry of looking incompetent, especially when new to a ward. Interviewee 2 beneath explained why he did not check the dose of an antibiotic in spite of his uncertainty: `I knew I should’ve looked it up cos I didn’t genuinely know it, but I, I believe I just convinced myself I knew it becauseExploring junior doctors’ prescribing mistakesI felt it was some thing that I should’ve identified . . . since it is quite simple to get caught up in, in being, you know, “Oh I’m a Doctor now, I know stuff,” and together with the pressure of men and women who are possibly, sort of, a bit bit much more senior than you thinking “what’s incorrect with him?” ‘ Interviewee 2. This behaviour was described as subsiding with time, suggesting that it was their perception of culture that was the latent situation as opposed to the actual culture. This interviewee discussed how he ultimately learned that it was acceptable to verify details when prescribing: `. . . I find it really good when Consultants open the BNF up in the ward rounds. And you think, properly I’m not supposed to understand just about every single medication there is, or the dose’ Interviewee 16. Health-related culture also played a role in RBMs, resulting from deference to seniority and unquestioningly following the (incorrect) orders of senior medical doctors or experienced nursing employees. A great example of this was given by a physician who felt relieved when a senior colleague came to help, but then prescribed an antibiotic to which the patient was allergic, in spite of getting currently noted the allergy: `. journal.pone.0169185 . . the Registrar came, reviewed him and mentioned, “No, no we really should give Tazocin, penicillin.” And, erm, by that stage I’d forgotten that he was penicillin allergic and I just wrote it on the chart without considering. I say wi.
