The issue of reporting an adverse event has been very cumbersome until lately. It has improved with Health Canada's MedEffect. Having said that, I would suggest that probably 60% of my colleagues aren't actually aware of its existence, even though it's been up and running for a while.
The difficulty with it is that the vast majority of primary care physicians, who probably write the vast majority of prescriptions in this country, aren't clear on what it is they're supposed to be reporting.
The side effects profile of a drug is documented in a thing called the Compendium of Pharmaceuticals and Specialties, which is a huge book and which has an arcane indexing system based on both the trade name and generic name. It takes probably four or five minutes to find the right page simply because of that. When you do, the information there, which is in very small print—and as you get a little bit older, that becomes an issue—is in a very logical and ordered fashion, but it's not usable. It doesn't tell me anything more about how that patient is likely to behave with that drug than I could have had, probably, without reading it, if it were a drug with which I'm familiar. Really and honestly, when you look in there for side effects....
I had a patient a few months ago who had what I thought was a significant reaction to an antibiotic I'd prescribed. They were jaundiced and they got worse, and I wondered if it might be the medication. I went to the CPS, and after 20 minutes of rummaging through there found that jaundice was a side effect of this particular medication. I stopped the medication, and the patient got better—and I did know more about it.
It was a significant adverse reaction, and it lengthened the length of stay with the patient. But the reason I stopped was that it was well known, well documented, and there was a percentage figure there in the book. Was my report going to add anything to the body of knowledge, based on what I understood of the system? I said to myself, no.
If you were dotting the is and crossing the ts there, then perhaps I was in some way culpable for not doing a report, but this is just a reflection of the utter lack of clarity about the current system. I didn't know whether it was a valuable thing to do, whether I was going to have problems with doing it, and whether it was indeed going to add anything. If it wasn't, then quite honestly I wasn't even going to spend the five minutes that would be required to log in on the Internet and do it, because I had other things to do.