Is Your Doctor's Bad Handwriting Dangerous?

If you’re like us, you’ve always assumed that pharmacists had a magical power that allowed them to decipher whatever was written on your prescription. But what if they don’t? Can your doctor’s bad handwriting lead to costly medical mistakes? Sure, according to the USDA there are 7,000 deaths a year caused by drug errors, and a quarter of those are likely caused by drug name mix-ups.

The Wall Street Journal Health Blog points us to a contest to decipher some especially bad prescriptions. We can’t read them. Can you? Either way, it’s a good idea to talk to your doctor about what he’s prescribing. That way, you’ll notice if you get Zantac instead of Xanax.—MEGHANN MARCO

If U Cn Reed This, U Coud Bee a Phrmcst [WSJ Health Blog]

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  1. catskyfire says:

    I admit that -I- can’t read it. But even with my own doctor’s very clear handwriting, I can’t read most of it. That’s because I don’t know Latin or the various symbols used in prescriptions. At a guess, I would think it’s “Take Before Meal.”

  2. Falconfire says:

    Twice I got into fights with CVS because they couldnt read the 4 refills on my script and just put in 1.

    I was actually told by the pharmacist to tell my doctor to improve his handwriting.

  3. davere says:

    My aunt owns a pharmacy. I’ve seen employees gather in the back to try to decipher a prescription and sometimes they just have to call the doctor to figure out what he was trying to write.

    Eventually they become familiar with the handwriting of certain doctors in the area and can figure out what they wrote. But it’s still scary.

  4. catnapped says:

    Don’t pharmacies have an OCR or does even that have it’s limitations?

  5. Ravenwaift says:

    I’m kind of lucky I guess. Most of my doctors are part of one practice in a large building. They have their own pharmacy on the 1st floor.

    They don’t use paper files, at least not that I’ve seen. Each room has a computer and is networked so that when they look up my name they can see what has happened at every doctor’s and my vitals over time. They also have to type in their prescription, and they just send it downstairs to the pharmacy.

    Basically, this means that if I have my OB/GYN appt and my family doctor appt on the same day, I don’t have to get my vitals twice. If I can’t remember the name of a prescription that I am taking, they can just look it up. If they want to put me on a medication that I was on before, same thing. They can chart my illnesses, reactions to medications, what medications worked, what didn’t, etc. between all of my doctors.

    It solves a lot of the problems of drug interactions and the like, but if I go to another doctor or if I take OTC meds, I still need to tell them. It isn’t foolproof but it is pretty awesome.

  6. MBPharmD says:

    @catnapped:
    That wouldn’t really help with anything. Scripts are full of abbreviations, shorthand, etc. For example, HCTZ = hydrochlorothiazide; PRN = as needed; QID AC/HS = four times a day before meals and at bedtime, etc.

    The best way to fix illegible scripts is by using either electronic prescribing (the script is submitted directly to the pharmacy’s computers – $$ and lots of issues with compatability between systems) or simply using computer-printed prescriptions.

    As a pharmacist, I find it interesting that pharmacy was virtually the first health profession to use computerized systems for record keeping in the 1970s…and many other disciplines have still not even made the first steps toward computerized records.

  7. tracilyns says:

    what year is it again? with all this technology available, why are doctors still handwriting prescriptions? my doctors have been printing prescriptions and then signing them for awhile now…why isn’t everyone doing this?

  8. phrygian says:

    My gynecologist prints out prescriptions and just signs them once they’re printed. I just wish my GP did the same. I don’t understand why more doctors don’t write prescriptions the print-and-sign way; it seems like it would save them time.

  9. Charles Duffy says:

    @tracilyns: I work at a company making an EHR (“Electronic Health Record”) product. Part of the functionality I personally implemented is faxing — so prescriptions are sent directly from the machine to the pharmacy; no handwriting involved.

    It was a happy day when one of our staff pharmacists mentioned seeing one of our prescriptions at his day job.

  10. Ryan Duff says:

    Most pharmacies spend their days on the phone with the doctor offices. If you ever listen to the background noise when you’re turning in a script, you’ll hear someone in the background making calls and putting the correct information into the computer. Sometimes they skip this when it’s just for a refill and you’re already in the computer.

  11. ElizabethD says:

    Yeah, I would notice pretty darn fast if I got Zantac instead of Xanax. My son with the acid stomach, OTOH, might still have a tummy ache but would probably be more relaxed about it if he got Xanax instead of Zantac. What fun to contemplate! (not)

    My primary care doc now generates prescriptions on computer workstations in every examining room; they get printed out nice and legible before I leave the office. That works!

  12. DashTheHand says:

    My doctor carries around a small tablet pc that has docking stations in each exam room with a little prescription printer. Makes it nice and easy to read. Now I just have to worry about the drooling hourly slave wagers behind the counter at Sam’s Club not giving me someone elses bag.

  13. nightbird says:

    Benadryl 12.mg/5ml
    0.5ml po q6h prn & q4h (can’t read)
    Dispense 120ml (4oz)

    I used to work in pharmacy. Where I worked, if there was any question as to the order, we called the doctor’s office to clarify. But this story is nothing new, it gets rehashed every other year or so.

    I would say the onus should be put on the prescribing doctor. If one is handed a script, you should look at it, if you can’t discern letters or numbers, ask him or her to rewrite it in a clear hand.

  14. ibuprofane says:

    Benadryl 12.5mg/5ml
    2.5ml every 6 hours as needed
    Refill 4 times

    (Last line decribes either what it’s needed for, or that it should be taken with another medication, likely irrelevant in this case)

    I used to work as a pharmacy tech, and we see stuff like this all the time. If there’s something that we can’t read, we bring it to the pharmacist, and is he/she can’t figure out what it is, then you call the doctor, it’s that simple. (On this one, the pharmacist would probably either call or look at any other precriptions that might give clearer instructions). Looking at a patient’s history also helps; it Bob’s been taking Lipitor for 5 years and his latest precription ran out and the precription kinda looks like Lipitor (and dosage, quantity, etc. match), it probably is.

    It’s always best to have at least 2 people working on your precription, one to fill and one to check. Anyone, including a pharmacist can make mistakes, but having two people checking helps solve a lot of potential problems.

  15. nightbird says:

    In regards to electronic or computer printed scripts, New York state supplies the doctors with script pads. Uniform size and design, and each script has unique serial number and bar code. The office I work in uses the tear-off pads, anyone know if high-tech versions are available?

  16. IC18 says:

    Its the 21st Century. Almost every hospital or Clinic in the country has a computer infastructre, take advantage of them and print the damn prescription instead of writing encrypted text.

  17. dragonflight says:

    @DashTheHand: Pharmacists actually get paid quite well, and I doubt that they are hourly.

  18. nightbird says:

    @dragonflight:
    I think he’s referring to the pharmacy technicians or cashier, who typically do get paid hourly.

  19. Red_Eye says:

    Unfortunately its a common problem and its just stupid. Whats even worse (at least in my area) are phoned in scrips. I mentioned on such ordeal here http://www.patentlystupid.com/node/48051 and I have had many more since then.

    It is very stupid, its a broken process and needs to be addressed. Most doctors get samples from the pharmaceuticals, why cant they get a #@$@##@! vending machine so you can just have the dr punch a few buttons and get you scrip in his office. I know the average pharmacy is prolly 200 Sq feet of space mostly occupied by shelving. A well designed machine could easily keep over 5000 medications in 1/10th the space in vertical tubes similar to what IC’s use. The vending machine could easily count the pills into the bottles, label them in a better manner than the stupid 10-20 stickers they currently use and even mix liquid products. Can anyone think of a down side to this other than people hacking it to get dope? The insurance companies would love this because they could uplink for approvals and if someone refilled a scrip too early they could deny it easier.

    A point and click ordering system could do this too.

    Some of our Dr’s have printed scrip now and those are the best. No hassles at all.

  20. Falconfire says:

    @nightbird: There are, but some states make it illegal under the false impression that they couldnt track a “printed script” never mind the fact that a constant problem is that the pads themselves are being stolen.

    Very recently my fiance and her boss caught one of their students with 3 script pads she stole from the gyno just that morning, writing out perfect prescriptions in Latin shorthand. The idea that people wouldnt know what to do with them if they got them is completely and totally false.

  21. mopar_man says:

    Is “shitty handwriting 101″ part of the course when you become a doctor? I don’t think I’ve ever seen one with legible handwriting.

  22. skippywasserman says:

    Having done quite a bit of this sort of thing in my career, here is why they don’t just have some sort of computer system for transferring this data around:

    1) The majority of prescription writers are small practices who do not have the computer infrastructure. The applications which can maintain an EMR (Electronic Medical Record) and generate prescriptions are expensive to run and even the best of them require extensive training of the office staff.

    2) There is no single standard with uniform interpretation in use. Several years ago a set of electronic message formats were put together and still these are not universally adopted nor are they implemented the same way. So you need heavily customized code for each connection so that your version of the electronic prescription is understood by each pharmacy’s system. Of course, having a simple message format would have been nice, but the messages were designed by committee and tend to be simultaneously highly redundant while not conveying the same data as the paper process they replaced.

    3) Once you get the data into the pharmacy you have a whole new set of problems: the systems used to track customer prescriptions are likely not integrated to the systems for making sure the correct drug is dispensed. It’s entirely possible to get the right prescription into the system and still dispense the wrong medication.

    Frighteningly, this is actually less of a bad process than claims submission, referral management, claims payment, and eligibility for care. If you ever want to see what a horrific mess our healthcare system actually is, try to follow the paper trail from the beginning of a routine visit which results in the need to see a specialist to the end of the payment cycle for everyone involved.

  23. Slytherin says:

    Fortunately, my doctor types up the prescription on the computer, and prints it out on a prescription-size sheet. Then he signs it and gives to me.

  24. raindog says:

    Yeah, I live in New York State, and while some of my doctors get the NY pre-printed prescription pads, my partner’s endocrinologist’s gigantic practice types stuff into the computer and he picks up the printed, signed scripts as he checks out.

    My prescription handwriting horror story takes place 3 months ago, when my partner had been taken to the hospital for the third time in a month for heart failure. The cardiologist on ER duty, whose name I could not understand and interpreted as “Dr Al-Jazeera”, was holding his cell phone with one hand to talk with someone in what we assume was Arabic during the entire initial exam, including when he wrote the prescriptions. (Yes, it’s probably racist of me to mention that we think he was talking in Arabic, but that’s not the point. The point is that he wasn’t speaking English and therefore he was most likely standing there in the ER taking a personal phone call while his patient was critically ill.) I assume that explains what happened next.

    When I looked at what the nurses had hung on the IV tree 20 minutes later, they had something hung that was similarly named to the heart drug they’d treated him with on previously visits, but which was not a heart drug. I asked them what it was for, and the nurse said she’d have to find a PA from cardiology to tell me. 10 more minutes went by and they hung a bag of the right drug. When I asked later what the deal was, they denied that the first drug had ever been there.

    After that, in addition to taking pictures of the staff rosters each day of his hospital stay, I took pictures of his pills whenever I was there to see them, and what was on his IV tree whenever it changed….

  25. Mike Tyson's movie career says:

    I have horrible handwriting, much like the pic posted. When I have to be read by anyone other than me, I use ALL CAPS. These guys should be encouraged to do the same.

  26. destijl says:

    I used to work as a pharmacy tech, for a few years at a wonderful independent pharmacy and also for just a few months at a CVS (before I vowed to never work pharmacy again). I remember when I was at CVS, a doctor failed to include a decimal point in a prescription for a baby that was just a few weeks old. I remember the rx was supposed to be for .2 milligrams of the medicine, but was written for, and the pharmacist personally typed and checked off on it, as 2 milligrams. The child was hospitalized.

  27. thrillhouse says:

    @nightbird:

    Very nice! I guess its a short hand of sort.

    I used to get certain prescriptions in 3 month supplies by mail. Trouble was when they couldn’t read the the handwriting on the prescription, it delayed the order. And delayed and delayed… I had my next appointment before the meds came in. And when the doctor asked if I’d been taking my meds… “lets talk about that…”

    Later I he started making notes for the nurse and she would transcribe them.

  28. Doctors know this is a problem so why don’t they do something about it?

    Is it not worth taking the five extra seconds to write it down neatly if it means not killing the patient?

  29. bluemeep says:

    That way, you’ll notice if you get Zantac instead of Xanax.

    Actually, I *did* get Zantac instead of Zyrtec once. Called the doc’s office while still at the drug store and they cleared it right up.

  30. rg says:

    If that was my prescription it would say something like “unlimited supply of demerol”!

  31. erica.blog says:

    Like many others who have commented, my doctor uses a printer to create prescriptions and then signs the printout.

    My father-in-law (a pediatrician) has been harassing the hospital where he works to go to such a system for years now because he’s tired of prescription problems (created by his own bad handwriting at times, he admits) — they haven’t switched over, nor given him a good reason for why. It may be worth it for the consumer to begin asking this as a question when looking for a doctor — “Can you do computer printout prescriptions to avoid misunderstandings from handwriting?” The benefits are obvious.

  32. My dad was a doctor for 40 years, and his handwriting is difficult — but not impossible — to read. Yes, it takes some doing, but it is nothing like this doctor’s completely illegible, potentially dangerous penmanship. Pathetic.

    I am a teacher. If my students can’t read my writing, they won’t learn about Shakespeare. (My writing, by the way, is quite a bit neater than my father’s.) If a pharmacist has to guess, someone might lose his or her life. This is serious.

  33. kenposan says:

    I have posted this story before:

    I work at a foster care agency. One of our kids saw the psychiatrist and got scripts renewed. The next day the kid was off the hook. I overhear the case manager talking to the foster parent getting a list of meds. I hear her looking at the psychiatrist’s note about what was prescribed.

    The pharmacy misread the psychiatrists scribble and gave the kid the wrong meds. The kid was essentially psychotic because of this screw up.

    My personal doc’s office uses paperless scripts. They have an automated system that sends it directly to your pharmacy of choice from their touchpad. The script is at the pharmacy before I leave the exam room.

  34. Wasabe says:

    I always liked the story about the doctor who wrote that eardrops should go in the patient’s “R. ear” – and the nurse put them into the patient’s rear!

  35. My doctors print prescriptions w/ the pertinent information on them already then they just sign them.

  36. raindog says:

    On the Zyrtec vs. Zantac thing, every once in a while my partner and I will be visiting a doctor and the nurse will be verifying all of his meds off a list, and she’ll ask, “And are you still taking Advair?” He never took Advair. He took Advicor but stopped taking it in about 2004. In that case, I assume it was someone other than a doctor writing down his prescription list illegibly, but the mistake has “gotten into the system” and pops up whenever we see a new doctor, or visiting nurse, or whatever.

    I’ve always been a little suspicious of the health care industry, but the last couple years have just made me sad and cynical about it.

  37. MarkMadsen'sDanceInstructor says:

    I must be lucky. My clinic types up all the prescriptions and emails them to the pharmacy, so I never need to worry about handwriting.

    All of the danger of handwriting would be eliminated if doctors bothered to realize that there were such things as computers and email…..

  38. Kornkob says:

    Email is not an acceptable method of transmitting personal medical data. It is not secure during the transmission process and can be interecepted, redirected or duplicated along the way between mail servers.

    This is why this isnt’ standardized yet. They need somethign secure, but not overly complicated or expensive so that small offices can afford to participate.

  39. tinychicken says:

    I think that nightbird and ibuprofane just proved how serious a problem this could be if a doctor is not called for clarification.

    Two folks with pharmacy experience.
    Two different translations. Yikes!

  40. Charles Duffy says:

    @skippywasserman: WRT even the best of EHR products requiring massive training time — the whole thing that makes ours different is that it doesn’t. We’re still working on scalability — you won’t see us doing hospital-scale installations just yet — but usability is our thing. Also, our prices are very, very reasonable — just turning on the HL7 integration option on some PMS systems costs more than our EHR!

    @IC18: Almost every clinic has a PMS — a “practice management system” that handles scheduling and billing. A full-fledged EHR (which handles patients’ medical records) is a very different thing; market penetration is much lower there.

  41. RJS says:

    A couple of things:

    1) Retail pharmacists are paid hourly.
    2) None of the guesses in this thread have been correct. The answers are posted.
    3) EMRs are still very expensive. Anything related to medicine is expensive because by its nature, it is a lucrative field. Most family docs, which is who most of you probably end up seeing, don’t actually make much money given the hours they were. The average is about $150K/year nationally with an average of 50 hours a week. Not much given the high barriers to entry to be a physician, and how late in life you start earning income. (Opportunity cost.) This is why EMRs aren’t more widespread: they’re too damn expensive. Specialists, naturally, bring in more. Here’s a good link:

    Physician salaries

    The “FP” entries are the ones you’re interested in. Many (most?) of the others practice in a hospital setting, and they use the hospital’s equipment, which usually includes an EMR, and aren’t pertinent to this discussion.

  42. hop says:

    why can’t the md’s just write plainly????????i know there are many shortcut words, but thet should still be legible….. it’s like some kinda tradition for doc’s to scribble……

  43. Crazytree says:

    @hop:

    why? because it’s part of a silly little subculture of making everything cryptic and unreadable by people outside of the “club”. then when patients die, the doctors can blame the nurse for “misunderstanding” the doctor’s order. yea… real fun when a Doctor is being deposed and he/she dumps everything on some underling. talk about personal responsibility. [rolleyes]

  44. chickymama says:

    @hop:
    Medical terminology is based off of latin. As one commenter stated above rt. ear can be misinterpereted. That is why abbreviations for left and right were created for specifice parts of the body. For example os and ou (i believe) are for right and left eye. When I worked for an ear, nose and throat doctor he would use au and as for the left or right ear. (I can’t remember which one is left or right).
    Any person who went to the school that I did to work in the medical field and I am not talking about the career schools, have to take classes in pharmacology and become familiar with all latin abbreviations. When you have nurses who are screwing up orders because they did not understand the difference between po and bo then there is a problem.
    Not all doctors have the money nor facilities to have electronic rx forms. The ENT that I worked for did not as he was a sole proprietor and did not write enough rx to warrant it, but the family practice that I worked for after the ENT did.
    I can sympathize when trying to decipher a doctor’s handwriting. The ENT’s handwriting was like a wave. Try figuring our tonsil hypertrophy from a wave.

  45. RJS says:

    @Crazytree: Wrong. Most of medical terminology has Greek and Latin roots, which is why abbreviations don’t make any sense to you or other non-medical people. It’s neither silly, nor arrogant. It just is.

    And docs get hit with frivilous lawsuits all the time, whether deserved or not. The reason is because that’s where the money is. There’s no money going after a nurse or any other member of the support staff.

  46. crankymediaguy says:

    “why? because it’s part of a silly little subculture of making everything cryptic and unreadable by people outside of the ‘club’.”

    I heard a great saying once: “Every profession is a conspiracy against the laity.”

    Anyway, my ex-wife is/was a hospital pharmacy director and this kind of problem crops up all the time. Pharmacy staff learns to interpret some doctors’ writing, but obviously that isn’t perfect.

    Believe it or not, some doctors are so arrogant that they will give the pharmacist or tech shit when he or she calls for clarification of a script. Apparently you’re supposed to have ESP on top of your pharmacy training.

  47. wesrubix says:

    @Ryan Duff:

    thank you Ryan Duff. You are exactly correct.

    Hand written prescriptions are just that, a PREscription. You don’t get anything until the Pharmacist agrees with and approves the medication selected by the doctor. These are entered into pharmacy inventory systems as required by regulation, and are verified before any prior entry.

    Messy handwriting does not endanger you! This is all waste-of-time journalism due to ignorance of how the field works. Pharmacists exist to ensure patients receive the correct medication for their problem(s)/symptom(s), because doctor’s make mistakes: pharmacists confirm the validity and correctness of precsriptions, and even at times (for their duty’s sake!) question and even CORRECT the doctor.

    As for OCR and electronic prescriptions, these do exist, typically within the same HMO or building. I’ve been to my PCP, said I needed a refill, and he sends it downstairs *eletronically* to the pharmacy.

    The only time it can’t be electronic is say oh I don’t know random Hospital USA to CVS. The are not interconnected. Why? Security.

    Stop being so freakin’ paranoid USA. If you have questions ask your pharmacist and/or your doctor. Wall Street Journal is not a medicine specialist! (And neither is Fox News!)