Dr. Stacie Bering: Curbing illegible cursive scripts

I broke the law last week. I didn’t mean too, really. I just forgot.

I wrote a prescription for a patient in cursive, meaning I hand wrote it in my (usually) acceptable handwriting. No pharmacist called me on it, so I guess I’m OK.

Some of my colleagues, I fear, are not.

On June 7, a law took effect in Washington state that requires prescriptions to be computer generated, typed or hand printed. No cursive writing allowed.

According to the Seattle Post-Intelligencer, Dr. William Robertson of the Washington Poison Center is willing to accept the “blame” for the bill. He’s worked for 27 years to make this law a reality.

I sympathize with him. Years ago, my husband was hospitalized with an intestinal infection.

When he was discharged, his doctor wrote a prescription for a medicine he was to take at home. I peeked but couldn’t make out what it was. Neither could Jeffry.

The pharmacist was stumped. So was his assistant. Heck, he might have even shown it to the cleaning lady to get her take on it.

Then the pharmacist called the doctor’s office. But the doctor had left town for a week, and none of his partners had a clue what the vacationing doctor had in mind.

To say that a scenario like this endangers patients’ health and safety is no overstatement.

It has been called “death by handwriting.” The Food and Drug Administration estimates that medication errors lead to 1.3 million patient injuries each year.

Not all of these are due to illegible prescriptions, to be sure. But by some estimates, more than 50 percent of written prescriptions are unreadable.

More than once, I’ve been in the nurse’s station in the hospital when the unit coordinator passed around a chart, asking if any of us could read what the doctor had written.

Illegible prescriptions result in over 150 million phone calls from pharmacists (and unit coordinators) to doctors each year as they seek clarification of medication orders. That’s a lot of time wasted on the phone, adding billions of dollars in lost productivity to the nation’s health care bill.

In Texas, a man died after his pharmacist misread his prescription medication but not the dose. He dutifully took the medicine, at 10 times the recommended dosage, and died of a heart attack. (One wonders why the pharmacist didn’t react to the unusual dosage, but that’s another story.)

I’m working in the hospital now as a consultant. This requires that I review a patient’s chart, including the notes that the attending physician and other consultants have written. And I am struggling.

I struggle to decipher what those chicken scratches on the page are trying to say. I struggle to understand what the writer is thinking about the patient’s condition.

I struggle to understand the plan for the patient.

In an era when doctors are busier than ever, these snippets of information are critical, particularly in complex patients where multiple physicians are involved.

We physicians get a bad rap for our handwriting, but a study showed that we’re really no worse than any other profession. It’s just that our lousy handwriting can lead to real harm.

Requiring that all prescriptions be typed, computer generated or printed is a good start. (Although there are a few physicians whose printing is as hard to decipher as the worst cursive handwriting.) This may come to be a moot point as more and more prescriptions are computer generated and integrated with office electronic medical records.

This has the advantage of having the computer check for patient allergies, drug interactions and correct dosages.

As for those hospital chart notes, requiring that physicians type their notes into an electronic medical record might be the answer. Even if they are two-finger typists like I am, at least everyone could read what they had to say, no interpretation required.

Dr. Stacie Bering is a Spokane physician. Contact her with general questions and topics for future columns by mail at Dr. Stacie Bering, Features Department, The Spokesman-Review, P.O. Box 2160, Spokane WA 99210 or by e-mail at doctorstacie@mac.com. She cannot answer personal medical questions in her column.