lucwarm and toadspittle, I imagine a combination of your answers is the best explanation to the question I originally posted. Nice to get the information on the patients’ responsibility, though. This has turned out to be an interesting thread. Thanks, guys.
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*Originally posted by toadspittle *
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*Originally posted by TomH *
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Man, where are docs accorded status and power? I wanna move there! After having spent the day arguing with an insurance company nurse about why the patient needs to be in the hospital instead of treated as an outpatient (she’s 88, not breathing real well, and can’t stand up for more than 15 seconds without getting dizzy, and oh yeah, she lives alone. But we’ll treat her heart failure at home!) and getting screamed at by a patient for not giving her the narcotic pain pills she wants for her headaches (she’s had all the appropriate tests to rule out organic disease, she gets headaches when she doesn’t take narcotics, refuses detox for her dependency, it’s illegal to prescribe narcotics to maintain an addiction!), etc. etc. etc.
Anyway, my handwriting is terrible, but I print all my prescriptions and instructions to patients to make sure they’re legible. I don’t know why my handwriting is bad, but previous posters points about how much we write, and under what circumstances, are pretty accurate.
I think as many physicians have good handwriting as bad, but which gets noticed more? And it’s true, when rushed handwriting deteriorates remarkably. I’ve made notes even I can’t read later. But, when I call a doctor to clarify an order and he/she spends more time yelling at me for not understanding it than it would have taken to straighten it out I vote for lack of professionalism/power of status. I actually have had a doctor tell me, and I quote, “You should know what I mean.” Pffft. Fortunately these kind seem to be the exception rather than the rule.
A final caveat-don’t think that electronic ordering systems will solve all the problems. We have one and you would not BELIEVE the number of ways people can still screw up orders. As long as humans are on the planet can there ever be anything “fool” proof?
As bad as it sounds, the unacecptable handwriting actually almost has a reason to it. I am a nurse, and have been for over two years. My signature, including my professional title, is nearly unreadable. With all the new, and almost daily Medicare regulations in place, I have to sign my name nearly 30 times per shift. After that many times, you tend to lose your perfect signature you normallly use. Blame the government…SPW
I had an attending who just signed “H” on the chart for his name. His handwriting was really no worse than usual, but he said that if a chart gets requisitioned by a lawyer, then the lawyer will usually sue everybody who’s signature he can read for malpractice. This is a pretty poor reason, I suppose.
There is little excuse for having bad handwriting on prescriptions or charts in which the patient is being managed by a team. But, sacrifices need to be made for time. In clinics, I usually spend 5-10 minutes doing an exam for a daily note, and then 10-15 minutes writing. One month in clinics, my team was following 40 patients. I was writing 15-20 notes a day (ICU notes). Believe me, my handwriting got worse.
Most prescriptions usually are neatly written, at least during my clinics experience. Messy prescriptions are inexcusable, and that doctor from the previous link deserves a fine.
I know that this is straying from the OP, but
For what it’s worth, I think “H” is making a mistake.
A persistent lawyer would subpoena enough records to figure out who “H” is.
Dr. H’s tactics would be used to demolish his credibility at trial:
“Now Dr. H, is it your normal practice to conceal your identity, or did you feel some special need to do it in this case?”
Objection! (sustained. Please refrain from argumentative questions counsel.)
“Dr. H, were you aware that by signing your name only as ‘H,’ it would make it more difficult to ascertain your identity?”
“And what was your purpose in doing this Dr. H?”
“And was this your regular practice, Dr. H?”
“And were you aware that this was against (some hospital regulation), Dr. H?”
“But you did it anyway, didn’t you?”
etc. etc. etc.
In my experience, surgeons are the worst offenders when it comes to chicken scratching. To understand this, you must understand the mindset of the surgeon–everything done outside the OR is done in a hellbent rush. (Not universally true, but close enough.)
Another important thing is that chart writing is usually redundant–the doctor will almost always be dictating the note as well. As such, the note is more for the doctor’s benefit than anything else. Still, it’s tough when you’re trying to read another team member’s note on an inpatient, or when it’s a prescription.
Edwino is right–part of it is time, and part of it is the bizarre language that we use. I can’t tell you how many times a day I write something like:
WD, WN 58 yo M, AOx3, NAD
HEENT: PERRL, EOMI, CN II-XII GI
CV: RRR, no M/R/G
Chest: CTA/P B, no CVAT
Abd: Soft, NT, ND, +BS.
Ext: no C/C/E.
To the layman, it’s total gibberish whether scratched out or typed out. The physician sees it and says, basically, “He’s OK.”
Dr. J
Interesting discussion but I’d like to know if there exists any objective evidence that the handwriting of practicing physicians is any better or worse than the handwriting of practicing lawyers, stockbrokers, bankers, parliamentarians, physicists, diplomats, pilots, army officers, automobile sales persons, flight attendants, etc. (after adjusting for age and sex).
For the most part, I agree with you, Zenster.
I take issue with laymen second-guessing physicians using references that are not intended for laymen. I can’t tell you how many people who have ended up in the hospital because they misunderstood a reference manual that was too technical for them. Not everyone understands that kind of technical language.
That said, there are many references designed for the average patient. The Internet is a wealth of information on medications, as is your friendly neighborhood pharmacist.
Finally, I work at a VA medical center that trains med and nursing students, interns, and residents. My job is to read orders and enter them into the computer. If I can’t read an order, have questions as to the dosage, route, frequency, etc., or if something is left out, I ALWAYS ask the doctor or pharmacist to clarify.
And everyone should do the same. When you receive a prescription, even if it’s for something you’ve taken for a long time, verify the name, dosage, route, and frequency with your doctor after he writes the prescription. If there are any changes, ask him why. Then, when you get the prescription filled, learn the color and shape of the pill or capsule, and ask questions. The best piece of advice my pharmacist-father ever gave me was not to let questions go until they’ve been answered to MY satisfaction. It’s MY body and MY health.
Robin
Another WAG would be that the pharmacist might, after seeing the doctor’s handwriting for a while, be able to pick out the slight nuances after staring at t for a while. This may help stop forgers. Maybe it works, but my guess is that docs do not so this intentionally.
In response to everyone griping about sloppy medical handwriting, I think it has nearly everything to do with the fact that so much has to be written, not a “power” issue. I have been a nurse for two and a half years, and I have had alot of first-hand experience with illegible handwriting. I work in a long-term care facility, and have had to call doctor’s offices more than once to ask what the heck was written. Frustrating? You betcha. Dangerous? Very. With all the new regulations in Medicare nowadays, I have to chart alot. My handwriting has suffered greatly as of late. My signature has become illegible, although I do make a concerted effort to make everything else readable. My point is this: when you have to sign your name 40 times a day, it starts to look like chicken scratch after a while. I realize, however, that my professional license is on the line, and DHEC can take that from me if it looks bad enough. In any case, time constraints or not, MD’s had better start watching that issue. It’s gonna take just a case or two more of negligence before some licenses start getting pulled. I worked long and hard for that piece of paper that lets me put a title behind my name, and doctor’s have to work a heck of a lot harder for theirs. The really sad issue is that it is the nurse who gives the med who will be charged with involuntary manslaughter in the case of a misread order. Wise up docs, before anyone else gets killed.
I know of no cases where doctors have deliberately tried to make the prescriptions illegible which would open them up to far more legal trouble than it would save. If anything is readable on the script, it should be the doctor’s name since the physician really does depend on the pharmacist to address the occasional error, scrawl or smear.
As for the messiness, just a simple matter of i)time and ii)the fact many patients are on tremendous numbers of medications; polypharmacy is a real problem for old people with diabetes, joint pain and failing hearts and kidneys – a very sizable population. I have seen people discharged on 25 medications. When you are already an hour behind and have four patients waiting in the emergency room and have to write out a prescription for 25 medications, see how much time you take. That being said, most docs I know have scripts that a pharmacist would be able to read easily. The code makes things more difficult for the layman, sure, but would be easy to learn if you wanted and is just done for the sake of brevity and tradition. If you think this answer is a sleazy cover-up, perhaps you could take Haldol 5mg PO qhs mitte 2 weeks and think about this whole thing again.
Also, I agree with the statement that surgeons are the worst. My first nursing job was for an orthopedic surgeon. He is considered one of the best orthopods in the state of SC, but boy does his handwriting suck. After working for him for almost a year, he flipped out one day when I asked what he wrote on a chart. He basically told me that if I couldn’t read his writing to find another job. Well, that, combined with other professional clashes, led to my resignation.
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“He basically told me that if I couldn’t read his writing to find another job. Well, that, combined with other professional clashes, led to my resignation.”
I’m glad you got out of an unpleasant situation.
Sorry to harp on the “power” issue, but I would interpret the above exchange as a person using (abusing?) his power.
Do you think that this doctor would cop this kind of attitude with a member of the board of directors at the hospital where he primarily works?
Assuming that the medical board exams have handwritten portions, it would be interesting to look at a year’s completed exams. I bet the handwritting is very good.
As I mentioned in a previous post, I dream of a day when nobody will have to endure the petty tyrranies we all suffer every day.
The surgeon to whom I am referring is a highly respected physician at our local medical center, who has practiced for nearlt 20 years. He is known around the hospital for throwing temper tantrums. He once broke scrub in surgery and threw his pager across the OR because a colleage was paging him during a difficult back surgery. He then proceeded to stomp the pager until it broke into many pieces. He has a very short fuse. He once burst into the examination room at the office while I was interviewing a new patient to obtain an H & P and told me “You’re taking too damn long with these people.” He then turned around and walked out. I was left in the room, highly embarrassed. After apologizing profusely and finishing the interview, the doc and I shared a few words about that issue. Yes, I am glad I am out of that place.
Because they write in latin, not english, right?
I know a teacher said to my son that he would be a doctor when he gets older. Why he asked? Because she can’t read his handwriting.
I’d hardly call it latin, just a few latin-derived abbreviations. for example:
Amoxicillin 250 mg #30
i po tid x 10d
i here means one, ii is 2, iii 3, you get the idea
po means per ora(?) or “by mouth”
tid means tri(3), i here means “times”, and d is deum
it’s all shorthand
sorry, d is dium, or day
“p.o.” is per oram.
“t.i.d.” is ter in die (three times a day)
I do think that the continuing use of Latin-derived abbreviations is questionable now that so few people are familiar with Latin. It just creates another, unnecessary potential source of error.
Just so you know-
I saw on a blurb yesterday that CBS Evening News, With Dan-Tanna-Rather, is having a story covering this exact topic on tonights broadcast.