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. Last Updated: 07/27/2016

Doctors Return to Penmanship Class




LOS ANGELES -- The class began with a gentle but humbling plea: "Pretend like you're in first grade."


For the next three hours, dozens of doctors at the prestigious Cedars-Sinai Medical Center in Los Angeles spent a grueling night last week confronting one of medicine's most notorious problems: horrible penmanship. Their own.


Shamed into attending by the hospital's chief of staff, they trudged into an auditorium with paper and pencil - and ringing cell phones - to hear two experts coddle and coach them to forget everything they know about handwriting and start from scratch.


Some came sheepish and left chuckling, but the session was hardly a joke.


"How we write something down for a patient can sometimes be a matter of life and death," said cardiologist William Mandel. "And we're realizing we could really use this kind of help."


Pulmonary specialist Andrew Wachtel had the same resolve.


"My kids think it's very funny that I'm stuck here tonight doing this," he said. "But most of us are trying to take this idea in the right spirit and give the lessons a chance. I admit it: I have terrible handwriting. It's just the result of how much we have to do."


Across the medical profession, concern is growing that serious errors in patient prescriptions and treatment are rooted in the age-old habit of harried physicians scribbling off requests that pharmacists and nurses have a difficult, if not impossible, time understanding.


Just six months ago, a Texas jury blamed a physician's illegible handwriting in the accidental death of a 42-year-old man who had a heart attack after receiving the wrong prescription. His doctor hand-wrote a prescription for 80 milligrams a day of Isordil, a medication for heartpain. But a pharmacist misread the order as Plendil, which is used to treat high blood pressure and has a maximum recommended intake of 10 milligrams daily, and gave him the same dosage. The jury ordered the doctor to pay several hundred thousand dollars to the victim's family.


A scathing 1999 report by the Institute of Medicine also concluded that a range of medical errors that include written miscommunication between doctors and other health-care providers may claim up to 98,000 lives annually. The research group, part of the U.S. National Academy of Sciences, urged hospitals and health maintenance organizations to be aggressive in tracking and reducing human errors.


U.S. President Bill Clinton has since asked Congress to create regulations requiring hospitals to get to the root of medical errors and make them public.


"We still don't have good data on exactly what errors occur, or how frequently," said Dawn McGinley, a spokeswoman for the National Patient Safety Foundation. "But we think the handwriting of doctors can be a factor."


For the past decade, the American Medical Association has asked doctors to improve their penmanship or, if that endeavor proves hopeless, to print prescriptions and add the medical purpose of the orders to avoid confusion.


Some medical centers are counting on help from emerging technologies. But the day when a doctor can recite a prescription to a computer that checks its spelling and even its dosage before relaying it to a pharmacist hasn't yet arrived - and when it does, it will be costly.


The Cedars-Sinai penmanship class had been in the works for months, after a staff survey this year revealed that poor handwriting was a major source of frustration. Nurses spoke wearily of having to chase doctors for translations of patient charts, which delayed care. Doctors said they were tired of getting telephone calls around the clock from pharmacists stumped by their written orders.


"There are so many drugs now that are so similar in spelling, and so many records that have to be kept with the way insurance has become," said pediatrician Sheldon Kishineff. "It's much easier for a mistake to be made."