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    Could you read that?

    There's growing intolerance for lousy handwriting. Here's how to fix that indecipherable scrawl.

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    Power Points
    Until recently, FP Fred Porcase of Jacksonville, FL, paid scant attention to a law his state passed in 2003 requiring handwritten prescriptions to be legible. Nor does he ever recall seeing a patient wearing a sticker stating, "I won't accept a prescription if I can't read the writing," courtesy of a campaign by the Florida Health Care Coalition, to reduce medication errors. But four months ago, the "prescription police" arrived at his office brandishing a prescription he had written and one from his partner, both illegible, according to the pharmacist who had filed a complaint with Florida's board of medicine. "The guy from the board slapped us on the hand and said there will be a fine next time, which got my attention," says Porcase.

    Although his partner has ignored the warning and continues to write indecipherably, Porcase now hands his prescriptions to his assistant, who types them out using e-prescribing software and transmits them to the pharmacy. While he's not happy with the possibility of having to hire an extra staffer to be his e-scribe, Porcase acknowledges that pharmacy callbacks to his office to decode unreadable prescriptions have dropped by at least half and that he likely won't have any more frightening drug mix-ups, such as when he prescribed DuraDEX for a patient's cough and the pharmacist filled it with the powerful diuretic Demadex—on two separate occasions. But Porcase scoffs at the notion of simply writing more clearly to avoid illegible prescriptions. "After 30 years of practice, no one is going to change my handwriting," he says.

    Pressure from all fronts to write neatly

    Besides Florida, at least four other states—Delaware, Washington, Montana, and Tennessee—have enacted laws requiring physicians to either print or type prescriptions or write legibly and to spell out months and other numerals. Sanctions range from $500 fines per illegible prescription to license revocation. But even in states without safe-scripts laws, lousy handwriting can land doctors in trouble with medical boards that audit records as a result of a malpractice case, patient complaint, disability claim, or other actions.

    Yet even in states that don't have a safe-script law, there's an increasing awareness that physicians' handwriting—wherever it appears in a medical office—ought to be more legible. In Maryland, internist John Steinberg of Randallstown offers a medical records "skills enhancement tutorial" to doctors who are being sanctioned or on the verge of receiving disciplinary action by Maryland's Board of Physicians. Steinberg says that most of the handwritten records he examines are illegible—and that physicians don't have a clue that they'll be held responsible if their unreadable writing causes a patient harm. "I strongly advise physicians not to rely on handwriting for the bulk of their medical records because it's a rare person who will spend enough time creating a record with adequate content that's also legible," says Steinberg. "An electronic medical record allows you to get 1,000 words in the template in the amount of time it would take you to write 80 words. And dictating that same record takes about three minutes." If physicians must write, Steinberg urges them to print.

    While The Joint Commission doesn't demand that charts be legible for hospitals to retain their accreditation, hospitals are responsible for addressing medication and communication errors that result from poor penmanship. "If handwriting isn't legible, physicians will have trouble communicating the processes of care as well as the specifics of medication, so The Joint Commission encourages and promotes handwriting legibility, the simplification of orders, and avoiding all forms of abbreviations and acronyms," says Peter Angood, vice president and chief patient safety officer for The Joint Commission. Writing clearly, says Angood, "has to be a conscious act" by physicians continually pressed for time.

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    Anita Slomski
    The author, a former member of the Medical Economics staff, is a freelance writer based in Evanston, IL.

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