Problems deciphering doctors' handwriting can prove deadly. Under a new state law, prescriptions must be printed or typed.
By LISA GREENE
Published August 2, 2003
[Times photo: John Pendygraft]
Ken Wurster, owner of West Shore Pharmacy, poses with an old, hard to read prescription, left, and a new typed prescription. A new state law cracks down on doctors' bad handwriting.
ST. PETERSBURG - Chelita Young found herself in familiar territory this week: waiting for the pharmacist to phone her doctor because he couldn't decipher her prescription.
"The doctor I go to - his handwriting is really bad," said the 30-year-old St. Petersburg resident.
So Young is vigilant. She has seen news stories about medication errors. She always talks to the pharmacist, checks the label, makes sure it's the familiar little yellow pill she takes for sleep apnea.
Still, Young was glad to hear that Florida has a new law governing doctors' handwriting.
For all the perennial jokes, a problem that might seem trivial can be deadly. In Texas in 1999, a jury awarded $450,000 to Ramon Vasquez's family after Vasquez's pharmacist misread his doctor's handwriting, giving him an overdose of Plendil, which lowers blood pressure, instead of Isordil, an angina drug. Vasquez had a heart attack and died a few days later.
About 6 percent of U.S. hospital patients hurt by medication can be linked to bad handwriting, says the Agency for Healthcare Research and Quality. Such drug reactions hurt or kill 777,000 patients and cost $1.5-billion to $5.6-billion each year.
"The most striking thing about the handwriting situation is that we're still using 19th century technology in the 21st century," said pharmacist Larry D. Sasich, research analyst with the advocacy group Public Citizen.
But how to fix it? The new law, which took effect July 1, requires doctors to print or type prescriptions and include complete dosing information.
Tampa pharmacist Bob Parrado, vice chairman of the state Board of Pharmacy, welcomes the new law.
Parrado said he calls doctors three or four times a day to check handwriting. The calls slow things down. But they're better than his nightmare of hurting someone with the wrong drug or dose.
"It's always been very bad," Parrado said. "We need to clean up the handwriting."
In the past few weeks, Parrado has talked to many doctors who don't yet know about the new law. But Dr. Kathleen Barry, a St. Petersburg family practitioner, said she has heard doctors sighing over the rules.
"There's certainly been some griping," she said.
Barry said her own cursive is so bad that she has always printed or used an electronic device. Cutting medical errors is important, she said.
"It takes a lot longer, but I certainly understand the reasoning behind it," she said.
The law is not the first effort to crack down on the problem. As attention to preventing medical errors has increased, several doctors and hospitals have taken steps to improve handwriting. Efforts include everything from classes to computers to contests.
At Shands at the University of Florida, Randy Hatton wanted to make doctors more aware of their handwriting problems. So Hatton, co-director of the Drug Information and Pharmacy Resource Center at Shands, put three samples of Shands' doctors' writing in a staff newsletter. Guess the medicines correctly and win a shot at a free meal.
Only 36 percent of the hospital staffers who entered got the right answers. And Hatton deliberately didn't choose the worst handwriting samples.
"It wouldn't be an interesting contest if everybody got them wrong," he said.
In real life, Hatton stressed, Shands pharmacists wouldn't guess about sloppy writing. Shands and other hospitals and pharmacies have strict rules: If there's any doubt, call the doctor.
Hospitals around the country weren't always so cautious, said Robert Neuwirth, director of patient safety at Morton Plant Mease Health Care.
"In the old days, when some physician had written an order, you would gather around four or five nurses, and they would try to piece together what it is and then they would vote," Neuwirth said. "That's a scary thing."
But pharmacists don't call if they don't realize they've misread. Zoloft or Zocor? Ceftin or Cefzil? Celebrex or Cerebyx? Hundreds of drugs have similar names.
Neuwirth has seen what can happen when a guess goes wrong. A few years ago, a friend's child was prescribed Claritin, a common allergy drug. Instead, the boy got Coumadin, a blood thinner that would rarely be given to a child. The child suffered internal bleeding but recovered.
The Morton Plant Mease hospitals have joined others that ban once-common medical abbreviations, such as "u" for units, which often is mistaken for a zero, multiplying the proper dose.
Hospitals are also turning to technology.
Many already have some type of computerized system for prescriptions, including Bayfront Medical Center, Morton Plant, St. Anthony's in Pinellas County and the St. Joseph's hospitals in Tampa. Some doctors now use computers or hand-held electronic devices.
But handwriting remains an issue. Sometimes computers aren't working or aren't available. Many doctors haven't yet spent the money on computers for their offices.
"The time will come, not far from now, when more and more of this will be automated," said professor Jay Wolfson, director of the University of South Florida's Suncoast Center for Patient Safety Research. "In 10 years, it's going to be the norm. In the meantime . . . it's difficult to read."
The future has arrived at the clinic run by Morton Plant Mease hospitals, the Turley Family Health Center, which has an electronic prescription system. There's a computer in every examining room for doctors to prescribe drugs. The computer cross-checks the doctor's instructions against its own data to make sure the dose is accurate and the drug won't interact with the patient's other medications.
In South Florida, the North Broward Health District has taken a different route.
It has brought in a handwriting team that specializes in doctors. Textbook authors Inga Dubay and Barbara Getty caught the attention of a California hospital manager. He brought Getty and Dubay to his hospital.
As word spread, Getty and Dubay began traveling the country, teaching doctors that bad handwriting is "like mumbling on paper."
The pair recently booked their 100th doctors' seminar, Dubay said.
Dubay teaches doctors the basics: close your A's and B's and other letters at the top. Give your letters the same height and slant. And get rid of big swirly loops - they make letters "look like spaghetti."
She also gives out an old-fashioned dose of manners. Doctors who tell her they write badly because they're in a hurry get asked how much time others have to decipher their writing. They get reminded that one really can't send a condolence letter by e-mail.
Dubay dispenses sympathy, too.
"It isn't that their handwriting is any worse than anyone else's," she said. "It's just that their's really counts. It can be a matter of life or death."
- Times researcher Kitty Bennett contributed to this report.
What if you can't read it?
If your doctor hands you a prescription you can't read, you shouldn't feel shy about speaking up, said professor Jay Wolfson, director of the University of South Florida's Suncoast Center for Patient Safety Research.
"The reasonable thing to do is say, "Could you please tell me what this is?' " Wolfson said. "The doctor will probably appreciate it."
In such cases, Wolfson suggests asking for information about the prescription, rather than being confrontational. If necessary, patients could also ask for a new prescription slip that is easier to read.
Patients should always check the name, dosage and special instructions about their medication with their doctor, and then again with their pharmacist.
