Montana MDs may soon pay for their scrawls

[Kate Gladstone]

In the US state of Montana, doctors may soon have to pay for their scrawls.

 

Bill # HB 254 (sponsored by Montana Democrat State Senator Christopher Harris) has passed the House in that state and gone to the Senate.

 

If the bill becomes law, it will authorize a $500 civil fine when a Montana doctor writes an illegible prescription.

 

For more information:

 

 

http://laws.leg.state.mt.us/pls/lAWS05/law...Find#spon_table

 

http://data.opi.state.mt.us/bills/2005/billhtml/HB0254.htm

[Cam]

I take it that this is being introduced to cut down on the danger of mis-reading the prescription and giving out the wrong medacine/dosage?

[georgem]

The pharmacy I go to ALWAYS calls the Dr's office to verify (umm...make that decipher) the prescription. My Dr. is famous locally for his "physicians' handwriting."

 

It's long been my theory that "physicians' handwriting" was a requirement for obtaining a medical degree. If so, my Dr could well be the maestro di scrivere at any of the local medical schools.

[Maja]

Well, as an ex-pharmacist, I can see a few loopholes with this law:

 

(a.) the case must be referred to the authorities by the medical licensing board before any legal action can be taken; if the licensing board doesn't refer it--> no legal action, no fine

 

If medical licensing boards are anything like pharmacy licensing boards, they are not overeager to throw their members to the wolves for some borderline "infractions"...but at the same time, for the sake of PR, they will probably report "repeat offenders".

 

(b.) what constitutes illegible for you may not be illegible to me and vice-versa; it is a very subjective thing

 

It's nice to see, though, that the bill specifies that "Each board licensing a medical practitioner shall adopt rules to implement this section".

Hopefully those with poor handwriting will try to improve before any fines are assessed.

 

And in case you think it is just doctors in emergency rooms who have poor handwriting (due to nature of their specialization) you would be very wrong. Some of the nicest doctor's handwriting I have seen was on prescriptions written by them

[mchristi]

Personally, I think 'scripts should all be typed. How the pharmacist ever turns those scrawls (my cat could write better) into medicine, I don't know.

Actually, I think that prescriptions should be electronically transmitted from doctor office to pharmacy. This would eliminate problems with legibility or other sorts of confusion. On top of that, the software could check drug interactions and other pertinent safety information on both ends. Any conflicts could be dealt with when the doctor is still seeing the physician. It could also automatically check insurance formulary information, availability of generics, and so forth.

 

Besides safety and problem solving benefits, it could also mean that the prescription could be ready for the patient by the time they arrive. I could say good-bye to waiting 20-30 minutes at Target while a pharmacist simply takes a box with a new inhaler in it off the shelf and slaps a label on it (and the latter step seems like a waist in effort and resources), a task that could have been completed in a couple of minutes while I waited at the counter.

 

Just as bad as some doctor's handwriting, at least from my perspective as a consumer, is the use of the strange script codes rathe than plain English. That alone might slow them down and make them more legible....

 

Mark C.

[Kate Gladstone]

Re:

 

" If medical licensing boards are anything like pharmacy licensing boards, they are not overeager to throw their members to the wolves for some borderline 'infractions' ...but at the same time, for the sake of PR, they will probably report 'repeat offenders'."

 

This seems probable: since opponents of the bill, before recent revisions in the state House, included the Montana Medical Association. (To appease the MMA, the House revised the bill to require that a pharmacist, rather than "a person of ordinary intelligence and learning" as in the original version, must find the Rx illegible.

(The MMA's opposition to the bill - in its earlier form, at least - strikes me as ironic because the American Medical Association has stated in writing, more than once, that it regards illegible handwriting as a major health-hazard. An article in JAMA [the Journal of the AMA] about 8 years ago - and another article about 15 years ago in the AMA NEWS - in fact recommended Italic handwriting as a preventive & cure for medical-penmanship woes.)

 

" ... illegible for you may not be illegible to me and vice-versa; it is a very subjective thing."

 

According to an attorney with whom I've consulted - my husband - probably in enforcing this law (if it becomes indeed law) the enforcement-agency will go by whether or not the pharmacist who got the Rx found it illegible.

 

"Hopefully those with poor handwriting will try to improve before any fines are assessed."

 

I've advised my two Montana colleagues (Ruth McDonald-Gates of Great Falls and Elizabeth "Betty" Darr of Bigfork) that they may want to advertise to doctors if the law goes through. A brief letter by me, suggesting that calligraphers may find a second job as handwriting-teachers for MDs, in fact appeared today (February 4th) in the GREAT FALLS TRIBUNE. (The TRIBUNE's web-site does not include its letters-column, so - if you want a copy of the letter and the editor's response - let me know and I will post it here.)

 

"And in case you think it is just doctors in emergency rooms who have poor handwriting (due to nature of their specialization) you would be very wrong. Some of the nicest doctor's handwriting I have seen was on prescriptions written by them"

 

The same here - one of THE nicest handwritings I've ever seen (and not from a student of mine, either!) came from an emergency-room doctor. She had (like a few other doctors and "just plain folks" whom I've met) independently discovered just about everything I teach.

 

 

"Actually, I think that prescriptions should be electronically transmitted from doctor office to pharmacy. ... "

 

 

So do I, for the reasons you gave, and so does George Bush, Junior who recently announced that the nation needs this done. However, the expense of this means that - for decades yet - we can expect to see handwritten Rx's: particularly in rural locations where they cannot afford to speedily computerize everything. (Handwriting classes cost far less than computers for every doctor.)

Case in point: many of the hospitals that call me for handwriting-help sheepishly admit that they "computerized everything" five or ten years ago. So why do they call me? They call me because ...

... sometimes computers go down

... some hospitals don't want certain kinds of records, or certain specific records, on-line where people could hack into them and read/steal them, put them on the Internet, etc. (Imagine what some people would pay on eBay for a complete copy of, say, Britney Spears' gynecological records ... )

... doctors and nurses who have computers still slap (oft-illegible) Post-It notes on each other's office/cubicle/workstation doors

... doctors with comptuers often ask their secfretary or ward-clerk to do the record-keeping: typing, of course, from the doctor's illegible handwriting, thus perpetuatin g errors indefinitely ...

 

 

"Just as bad as some doctor's handwriting, at least from my perspective as a consumer, is the use of the strange script codes rathe[r] than plain English. That alone might slow them down and make them more legible...."

 

More and more hospitals do indeed now require "plain English" rather than permitting Latin, symbols, abbreviations, etc. This has increased my business for two reasons:

/a/ it "slows them down" as you say - meaning that they must find some waqy to write faster yet still remain legible, if they want to keep doing their work at the necessary rate (often 500 Rx's per doc per day in a busy hospital)

/b/ when they have to write "left ear, twice a day" instead of "AS bid" - or when they have to write "increased" on a medical chart rather than just drawing an "up" arrow - this plainly demands more of them in the way of accurate letter-formation at speed.

[Maja]

  I could say good-bye to waiting 20-30 minutes at Target while a pharmacist simply takes a box with a new inhaler in it off the shelf and slaps a label on it (and the latter step seems like a waist in effort and resources), a task that could have been completed in a couple of minutes while I waited at the counter.

 

Sorry, but that is one of the big misperceptions about my ex-profession...If that is all we had to do, do you think I would have left such an easy job due to burnout after a mere 15 years?

 

 

Trust me, it ain't as easy as it looks.... <_< There is more to being a pharmacist than lick, stick and pour....

 

The reason that you have to wait for prescriptions is all the other people ahead of you who are waiting.....

[Maja]

PS. Even if a prescription is transmitted electronically to a pharmacy, it still has to wait in the queue with the prescriptions ahead of it, waiting to be filled...Nothing's perfect

 

Electronically-generated Rxs are a good idea, though, and I have filled many of them.

[mchristi]

Having a couple of questions/comments, I'm moving over to chatter.

 

Mark C.

[Kate Gladstone]

Re:

"... I'm moving over to chatter" -

 

- please tell me about "chatter" and how one gets there/does it.

[Maja]

Re: 

"... I'm moving over to chatter" -

 

- please tell me about "chatter" and how one gets there/does it.

"Chatter" is just another Forum (like Penmanship) here on FPN, Kate---link here. It's the 11th one from the top of the FPN homepage....

 

The "chat room" on the other hand, is located here: www.tryphon.it/chat

if you want to indulge in real time live internet chatting with other pen enthusiasts

Edited February 5, 2005 by Maja