The majority of errors are caught — by the prescriber, by the pharmacist, or by the nurse administering — but a few fall through the cracks. Order of magnitude errors, where the dose is x10^n the intended dose are some of the more common errors.

We have a lot of safeguards — for example packaging medications in dosages that are likely to be safe for a single dose — but there are also some factors that make errors more likely, such as paediatrics (who need smaller does), geriatrics (who often have many different medications which can interact), and critical care (where things move fast, and big doses might be needed).

I'm a student doctor, and hopefully you believe me that medicine is hard. Electronic systems might help with some of the hard bits, but they're often a hindrance, or pose their own hidden dangers. As a software engineer I know that a lot of medical software is far from fit for purpose.

No, the medical system isn’t perfect. It’s made up of humans, shocker. Ignoring the cost (in America), it does pretty well most of the time, and I’d rather blindly trust people who study medicine for 12+ years than someone who would otherwise try to drain my blood and balance my “humours”.

I'm still of the opinion that most people are better off letting doctors and nurses do their job than trying to manage their own health based on stuff they've read on the internet. There's a lot of bad information out there and sorting through it takes practice. You have to enjoy reading medical literature more than blogs.

The specifics: he's in a home hospice care situation as a result of severe aortic stenosis along with some complicating factors. Hospice is designed to provide "last two weeks" care for their patients, and they have a specific drug cocktail for that, but he's been on home hospice for over a year now because his body just isn't done yet, and there is no death-with-dignity law in his state (nor available providers in the neighboring state).

The drug cocktail is an opioid, usually morphine, along with a benzodiazepine, usually Lorazepam (generic Ativan). Taken together, they help relieve anxiety, reduce respiratory distress, and lower blood pressure. That last is important, because the morphine/benzo cocktail is specifically cautioned against in medical literature for elderly patients who are still ambulatory, because it creates a fall risk. They go to stand up to use the bathroom, and there isn't sufficient blood pressure to stay conscious, and they pass out and hit the floor, hard.

And that's exactly what happened to him. The third time, it hospitalized him and, because his speech had been slurred and his consciousness had been altered before the fall, I suspected his medication wasn't right. I went out there and carefully went through everything, and sure 'nuff, that's what it was.

The doctors just prescribed whatever hospice asked for, and hospice just asked for their usual recipe. It took an annoying number of meetings with staff before a younger visiting physician dropped in to one of the meetings and followed up with the literature I was citing. The next morning they started reducing his dosages and he began recovering, including getting his mental faculties back.

He's been back home for a couple of months now, doing well.

Physicians aren't magic. But, they work in a field that's totally alien to most of us here on HN, and trying to navigate the field as a layman can easily lead you into some pretty woo-woo nonsense. Trust, but verify.

Too many close calls over the years. People make mistakes, it happens, ultimately the patient needs to be responsible for their care or have someone acting in their best interests.

Of course all of this gets into things like medically informed consent and patient goals.