Why do doctors have such poor writing skills

Doctors and Handwriting: Is It So Bad It Accidentally Kills Patients?

The source behind the Time article is a July 2006 report from the Institute of Medicine entitled "Preventing Medication Errors: Quality Chasm Series." A letter (PDF) is available online and the information here is taken from it.

The subject turns around adverse drug reactions (ADEs), including errors caused by incorrect prescriptions:

Some of these "Adverse Drug Events [ADEs]," as drug injuries are commonly known, are inevitable - for example, the more effective a medicine is, the more likely it is to have harmful side effects - but sometimes the harm is caused by a mistake in prescribing or taking the drug, and such harm is not inevitable. You can be prevented.

The number of avoidable ADEs is extremely large. The report suggests that a typical hospital patient experiences at least one medication error every day. Various studies have claimed 380,000 and 450,000 preventable ADEs per year. The committee behind the report takes these low estimates into account.

For example, one study calculates that 800,000 preventable ADEs occur in long-term care facilities each year. Another finds that Medicare outpatients experience 530,000 preventable ADEs each year.

Again, these numbers are judged to be low, and it should be noted that none of these studies have prescriptions that should have happened, but never - omission errors. The committee concludes with the number of 1.5 million preventable ADEs occurring in the United States each year as a lowball estimate of which of the numbers in the time article will be used. So far, so good.

Unfortunately, these numbers are not broken down further in the letter. The only mention of the manuscript is in a section on how the use of new technology can help:

The use of electronic prescriptions or electronic prescriptions is even more promising. By writing prescriptions electronically, doctors and other providers can avoid many of the mistakes that come with handwritten prescriptions, as the software ensures that all of the required information is filled out and legible.

The note on legibility is hardly the focus of the section here. While it admits that poor handwriting plays a role in preventable ADEs, the letter alone does not provide sufficient grounds for the Time article's comments that "doctors' sloppy handwriting kills more than 7,000 people annually." While searching through the full report, I found a few more clues about handwriting issues:

Poorly handwritten prescription orders are the main source of misunderstanding between prescribing doctors, nurses, and pharmacists and have often resulted in serious injury or death due to misunderstanding of the drug or its dosage, route, or frequency (Cohen, 2000).

There was also a note too Transcription errors which could be seen as a container for handwriting errors. One study identified 29 of the 334 errors found as transcription errors. But nowhere in the report do I have an estimated number of Deaths found for something specifically aimed at handwriting.

Upon closer inspection of the Time article, I realized that writing might just be difficult:

Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and according to a July 2006 report by the National Academies of Science's Institute of Medicine (IOM), preventable medication errors injure more than 1.5 million Americans annually.

The 1.5 million statistic is from the IOM report, but the 7,000 people killed are completely without sources. The Straight Dope comments:

Actual statistics, apparently drawn from a 1998 Lancet paper on subsequent Institute of Medicine reports, say that 7,000 deaths each year in the United States are due to all drug failure of any kind in and out of hospitals and not only to those associated with poor penmanship.

The time article was a long way off in terms of their statistics and contrasted these statistics with an unrelated source. But the direct answer to the question, "Does bad handwriting kill people?" is that yes, it can if it is the underlying cause of ADD that leads to patient death. Is it a common problem? Not compared to the other preventable ADEs.

MrHen

In other news articles I should probably stop assuming that Time articles legitimately contain their statements. This answer is a little longer than necessary since I started out from the IOM report. : P.

Mike Dunlavey

+1 It's long but very interesting. Even if the number 7000 is a factor of 100, it answers the question in the affirmative. Another source of error I've seen with electronic prescriptions myself is that administrative staff can mess up prescriptions because they do the reordering and often change insurances and wording and move patients from one pharmacy to another. Pharmacy staff and patients really need to be on their guard.

MrHen

@ Mike: Yes, in fact, this source of error is also covered in the full report. Unfortunately, pretty much can everyone Step of the process contain errors.