March 27, 2008

Sloppy Handwriting On Prescriptions

Stupid Question ™
May 27, 1999
By John Ruch
© 1999

Q: Why do doctors often use sloppy handwriting on something as important as a prescription?
—Tyrannosaurus Rx

A: Part of the medical profession’s bad-penmanship reputation goes back to the 1400s, when prescriptions were written entirely in Latin specifically to be unreadable to laypeople.

Even today, prescriptions employ a weird mixture of Latin and English abbreviations. “Aspirin, Disp. 50, Sig: I tab po qod ac & hs dur.dolor” might look like sloppy scrawl to you. But to a pharmacist, it clearly means issuing 50 aspirins to treat pain, with one tablet to be swallowed every other day before meals and at bedtime.

Nonetheless, many doctors do have lousy handwriting. In a 1979 study reported in the “Journal of the American Medical Association,” 16 percent of tested doctors’ handwriting was deemed illegible by peers.

Several surveys have found that about 2 percent of prescriptions result in medication errors. A 1987 survey of community pharmacists found them catching an average 4.1 prescription errors a week.

While there’s no data on how many errors are specifically due to bad handwriting, it certainly contributes to two main problems: confusion of similarly named drugs, and misreading of dosage figures.

Sloppy handwriting is usually attributed to modern doctors having many patients and little time. All writing must be done very quickly. And many medical schools provide no formal training in prescription-writing.

Until very recent times, there was little chance that scrawled prescriptions would confuse a pharmacist because there were few drugs to choose from. In the early 1900s, there were only about 10 basic drugs. Today, Ohio State University (OSU) Hospitals stock about 1,500.

According to Jerry Siegel, director of the OSU Medical Center pharmacy, the explosion in the number of drugs began only this decade, with 350 new drugs coming out last year alone.

Prescription errors are a growing problem, but doctors are used to letting pharmacists catch their mistakes. Pharmacists spend a lot of time calling back doctors’ offices to check unclear parts of prescriptions. That’s why you must often wait so long to pick up medicine.

“I can give you the wrong thing so much faster,” Siegel says.

The U.S. has no law requiring that prescription handwriting be legible. In one landmark case, admittedly bad handwriting resulted in the cancer medication Tamoxifen being replaced with the heart medicine Tambacor. The pharmacist was held liable; the doctor wasn’t.

However, awareness of the problem is growing. The American Medical Association has suggested that doctors improve handwriting and avoid abbreviations.

There’s also a major move toward electronic prescription computer systems that, while having their own problems, virtually eliminate handwriting errors.

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