So That’s Why I Can’t Read the Prescription!
How many times have you wanted to call the doctor and say “Seriously dude, really? Is that what you wrote?” While I have avoid saying “dude” in my professional conversations, that about captures what goes through my mind. Doctor’s handwriting – this is an old and much discussed topic of frustration, but still worth a mention. Just because it’s frustrating, yes that’s one reason, and I like to complain, but also because the chance of an incorrect drug being selected also increases.
If the writing is straight out illegible, this is almost a better scenario than writing that looks very much like one drug, when the doctor intended another. The very similar looking scrawl is the problem. For example, Lipex and Lasix. When typed, it’s pretty obvious, and you’re thinking (if you’re not used to this enjoyable task of drug deciphering) hey, that’s pretty easy, one has a “p”, the other has an “s”, how can you confuse the two even though the do appear similar, silly pharmacists! The problems is the doctor’s handwriting is highly variable. Some print, some link-script, some cursive and some come up with their own ’style’ as a way of ensuring their writing on a script is distinctive and hard to forge, that the nice reason, the bad reason is they’re just in a hurry.
Regardless of the reasoning for it, the outcome is the same, increasing the chance the wrong medication will be selected. Back to my example of Lasix and Lipex, in some cases, the dose or the strength will tip you off. It might look like drug X, but you know that 100mg is silly, or it’s not likely to be used three times a day, so that will be a red flag to indicate it’s probably not the drug that appears to be written, and then you’ll realize the right item. With Lipex and Lasix, 20mg or 40mg is a standard dose for either, and so is once a day dosing. Possibly the number of tablets or capsules written on the script will give you another clue, but unfortunately we know doctors usually don’t know quantities and write 28 or 30 for a month, or just write 100 if they are guessing. I’m not saying this is something doctors must know, they have other things to think about, but its just another variable that isn’t a reliable indicator of what product they’re after.
You might now be saying (particularly if you are a non-pharmacist) “well, if it’s that confusing looking why don’t you call the doctor?”. The times it is confusing we do, of course, but there are going to be those instances that the doctors scrawl looks exactly like one word, but we don’t know they happen to loop their “s” or their “p” and therefore it actually isn’t the letter we think (and most people) would read it as. Considering around 70% of handwritten prescriptions (or let’s say the majority, my stats are my own, I’m not claiming I’ve done great research on the topic, but most pharmacists would probably agree) tend to be of the scrawl/short hand type. If we were to call the doctor everytime a prescription appeared that wasn’t written comparable to neat print, we would need to call the doctor every 3rd script roughly.
Lipex and Lasix, the first is for cholesterol and the second is a diuretic (helps you lose fluid, an important factor to ease the load on the heart in certain patients, or if for whatever reason they are accumulating fluid). If someone were to go unnoticed on the cholesterol medication and have their fluid retention continue to put stress on their body/heart, there can be dire consequences.
What is the solution. Pharmacists to be more careful? Yes. Doctors to write neater? Yes. Computer generated prescriptions…hmm, Yes? Maybe? What’s wrong with computer scripts you say since they nice and typed print? Typos that’s what, or to be more accurate, incorrect selection. The doctor might hit the wrong drug in the menu while speaking to the patient, so even though you’ve got a nice shiny neatly laser-printed prescription, it might be for METOprolol when METOclopramide was intended. In some cases the doctor writes an item because they are thinking of the next or previous patient, or the patient’s spouse if they are there at the same time. We all make mistakes. Instead of giving your customer the latter medication to control their nausea, you’ve given them a blood pressure medication, and if they’re already nauseous and dizzy to begin with, this dizziness is likely to be compounded and they may have a fall or worse.
We can’t just blame the doctors for having slack writing or forgery-proof handwriting, we need to talk to our customers, most of us do that already, but this is more for the pharmacy students that might be glancing over this site, it almost January and a bunch of you out there will be newly registered pharmacists. If it’s a new medication, you need to talk to the customer. A simple question such as “Have you had this before?” and showing them the item can be a lifesaver, or at least prevent someone getting crook. If they haven’t had the medication before according to your drug history on the dispensing program, that’s a great reason to go out and ask. If they’ve had a solid record of having the drug, and it looks like what you think it is, it’s a little more reassuring, but if it’s a new one, you should be speaking to the customer anyway. If you’re swamped with scripts, make a note on the item that patient needs to be questioned, and have your assistants trained to get you if its new so you can discuss it.
So yes, we can still be frustrated at the doctors, will can still let them know when their scripts are unreadable, but we also need to make sure we don’t get into a comfort zone of making assumptions. When we’re newly registered pharmacists, as some of you may recall, you probably triple or quadruple checked your prescriptions, and if you had any doubt, you were all over it like a monkey on a banana. When we get more confident, that is when the risk of relying on our assumptions comes through. There’s no room for assumptions. Good luck to those new 2010 newly registered pharmacists, and even though you’re registered and all grown up, don’t be ashamed to ask your fellow workmates if you’re not sure what you’re doing (or can’t read a script!) it is much easier than having to do it after you’ve done the wrong thing. Yes, and again, good luck!
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