Friday, June 18, 2004

Use a Pen, Go to Jail

Back to a slow week, just 2 patients. That's the way it's going to be: unpredictable. It's been 4 months since I opened my solo practice and I've seen 36 patients so far. I've got a long way to go...

I signed up for an online billing service today called Medrium. It's about time I got paid for seeing some of these patients. We'll see how easy (or difficult) it is to use.

Here's an article from today's site on doctors and computerization, appropriately title: "Dragging Doctors to the Info Age" that suggests a topic for a rant:

Since 1999, then, hospitals have slowly brought in more computers, focusing largely on so-called Computerized Physician Order Entry systems that force doctors to type in prescriptions instead of writing them on paper. Not surprisingly, some deadly errors occur when pharmacists misinterpret physician handwriting. In one 1995 case, a Texas man died because a pharmacist thought his doctor had ordered the high-blood-pressure medication Plendil instead of another drug called Isordil. The patient got eight times the safe dose of Plendil. (Wachter showed the handwritten prescription to 158 doctors and only a third thought it was for Isordil.)

"Only" a third? That's not very reassuring. And this:
Computers, of course, have limits. Notwithstanding computerized physicians on Star Trek, technology won't turn an incompetent doctor into a competent one or provide the intuition that nurses rely upon when they treat patients.

The point, Wachter said, is to provide backup systems to warn hospital employees before they make mistakes. "We're not going to fix these sorts of screw-ups by advising people to be more careful. They'll just blow it again," he said.

Computerization may help, but typos happen to (sic).

You'd think that highly educated doctors could learn to be more careful. But I agree that that is not likely to be the answer.

As studies (here, here and here) have shown, doctors as a group do have bad handwriting. I have personally known a select few whose penmanship was so illegible that even they have trouble re-reading what they wrote. So, as a profession, it's our own fault.

While some think the solution is forced computer entry, preprinted prescription pads or "aggressively educating" patients what medications they take and why, I think a simpler solution is at hand, yet one that will rarely be followed: handwriting classes. It is such a simple and low tech idea and addresses the root of the problem. As an English major, I have always prided myself in my handwriting, or rather my printing (I haven't used cursive writing since high school). One of the nicest compliments I get is from patients who look at their prescription and say, "Gee, you sure don't write like a doctor. I can read what you wrote."

Admittedly, my handwriting has gotten worse through the years. Plus I realize that lack of time plays a role in how quickly doctors scribble their notes and prescriptions. But are careful doctors also more careful about their handwriting? Or vice versa, are doctors who are careful about their handwriting also more careful in their medical practice?

I confess that I have a prejudice against bad handwriting. I sometimes feel that, rightly or wrongly, a doctor's handwriting correlates with his or her competency, or more specifically, their attention to detail. Whenever I read a consultant's report or progress note that is illegible, I think, "This doctor didn't take the time to give me a comprehensible note, so he probably didn't take the time to do a good job evaluating the patient either." I realize that this is probably not true, that there may be excellent doctors with chicken scratch handwriting. But it is certainly not something that bolsters a lot of confidence for me.

So write neater or the alternative is this.