Oncologist attributes prescribing error to systemic cognitive overload

Australian oncologist Ranjana Srivastava has published an opinion piece in The Guardian detailing a prescribing error made at the end of a long shift, attributing the incident to systemic cognitive overload rather than individual negligence. Although a pharmacist identified and corrected the dosage before administration, ensuring no patient was harmed, Srivastava states the mistake remains a significant concern that highlights broader failures in the healthcare infrastructure.

Srivastava, an award-winning author and Fulbright scholar with 25 years of clinical experience, wrote that the error occurred after managing an outpatient cancer clinic and inpatient rounds on a busy medical unit. Her team cared for 30 patients aged 25 to 100, a demographic presenting with complex, competing needs ranging from disability and mental illness to dementia and organ failure. She described how the cumulative weight of these interactions created a dense mass of clinical and social issues that saturated her capacity.

The oncologist rejected common explanations for medical errors, such as poor sleep or slipping attention, noting that experienced clinicians are typically adept at filtering noise. Instead, she identified cognitive overload as the primary cause, driven by an excessive patient load where prioritisation between critical conditions is inherently difficult. She argued that while human error is inevitable, the system should not be structured in a way that makes such mistakes likely when lives are at stake.

Srivastava characterised the current healthcare model as unfit for purpose, citing overcrowded hospitals and a lack of appropriate community-based support. She noted that nearly half of her inpatients could potentially be managed in the community, with many requiring social workers, allied health interventions, or mental health providers rather than medical doctors. The article highlighted that nursing home residents and patients with primarily social needs are often inappropriately hospitalised due to a lack of alternative care pathways.

The author called for political courage to restructure care delivery, suggesting that reducing hospital demand through better community and allied health interventions is a more realistic solution than simply training more doctors. While initiatives such as virtual emergency departments have been introduced to alleviate pressure, public hospitals remain the default pathway for most patients. Srivastava concluded that the reflex solution of employing more doctors is insufficient, arguing that patients deserve better care delivered in the right place by the right people.