Why Do Doctors Still Write Prescriptions (Illegibly) When They Can Type Them?
from the seems-simple-enough dept
Reuters is running an article talking about how folks in India are urging doctors to stop writing prescriptions so illegibly, as it all too often leads to filling the wrong prescription (even to the point of putting someone's life at risk). However, this is hardly just an Indian issue, as the same thing happens in the US as well. In an age where more and more doctors' offices are computerized, it simply doesn't make any sense not to offer computerized prescriptions that accurately display the drug in question (including, perhaps, questions or warnings about possible conflicts or side effects). The fact that it may save a few seconds for a doctor to scribble hardly seems like a reasonable excuse when people's lives are on the line and it's part of the doctor's job to do whatever possible to keep them healthy.
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Filed Under: doctors, handwriting, india, prescriptions
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Luddites
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Re: Luddites
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My Doctor Electronicly transfers the script to my drugstore of choice
1. The prescription goes to the drugstore in a legible format.
2. The prescription arrives at the drugstore before I do, reducing my waiting time.
3. The prescription arrives at the drugstore, and doesn't get lost in my car, or blown out the window, or put off till later, and lost with other paperwork.
4. If there was a problem, or it went to the wrong store, I can call up my doctors number, and a tech can re-route it to the correct store. (This is mostly useful for recurring prescriptions conflicting with my own forgetfulness and travel needs)
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Re: My Doctor Electronicly transfers the script to my drugstore of choice
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Kaiser went digital
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Re: Kaiser went digital
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Re: Re: Kaiser went digital
I have Kaiser as well, and their system is pretty slick, overall.
EtG
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Re: Kaiser went digital
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Doctors in the UK
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Re:
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http://www.surescripts.com
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the ego tradition
the reason they do is because it feels awesome to scrawl something on a piece of paper and watch nurses, patients, and everyone else treat it like a gift from god.
updating records in a database does not feel awesome, so they won't do it.
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Re: the ego tradition
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Scribbling
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Why should doctors have to type?
The reason docs don't type this up as it will take them longer and they view it as someone else's job. This is like asking Moses to type out the 10 Commandments after he's given them too you.
And honestly the UI to enter in this stuff is painful. Why should a doctor have to figure out the UI to enter in a drug when he already knows it? Instead we force them to select "Levotol" from a dropdown list, then a dropdown list of what size to give the patient then a combo box to select how long, etc etc.
The doctor just wants to get things done and writing out "300mg Levotol" is the fastest thing. Maybe if the UI of medical apps caught up with that more doctors would type it in (or more likely use speech to text, if they didn't have to correct it).
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wait, what?
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Re: Why should doctors have to type?
The argument that they are "too busy saving lives"?? I mean, are they in a war zone? An extra 2 minutes per patient is not going to bring down their daily average of viewed patients.
If the doctor isn't willing to use newer technologies (everyone knows that medicine reached its pinnacle of knowledge when the ballpoint pen was invented), then get someone else to input the information but the prescribing doctor should be confirming the entered data.
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Re: Why should doctors have to type?
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Re: Why should doctors have to type?
Shit man, the post even says that when a doctor scribbles the prescription, the wrong one might be given which causes life threatening side effects.
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Re: Why should doctors have to type?
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I can tell you exactly why drs don't use computers
Doctors and computers mix like water and oil. With a patient load, doctors don't often have the time to sit down and use a computer, thus, it's faster to write it out.
Moreso, doctors often aren't trained properly in the use of the program to which they're supposed to use and this too leads to the dismissal of technology.
In many clinics, it's usually left to office personnel to "fill" the prescription, even going as far as setting it up to the patient's pharmacy.
This is no different than a patient not looking at the prescription to determine if they can read it, which would be the first indication of a possible problem.
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Just kidding... but seriously some doctors suck at writing. I think it's a game of wits they place with pharmacists or something.
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not just prescriptions
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1) For private or even small group practices, it costs a lot of money to upgrade to EMRs (electronic medical records) which you need to write electronic scripts. It then also costs more money to "add on" the ability to electronically handle scripts
2) Not all managed care companies are up to speed on handling electronic scripts.
3) Not all pharmacies are up to speed on handling electronic scripts
But we need to go back to #1 - it costs MONEY. And in today's age with very low reimbursement rates for doctors, high malpractice and insurance costs, electronic scripts ARE NOT COST EFFECTIVE.
Some states have laws about illegible scripts - that should help some. Consumers need to be more aware of what they are taking and check the script they recieve from the pharmacy.
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Re:
2)I guess they cant read (electronic = print)
3)Ok for this one I will take electronic as electronically transmitting. The large places have it set up to receive them now the smaller ones are currently able to receive by fax as an alternative. In 2010 they will not be allowed to receive them in this way and will have to convert or go out of business.
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Doctor's Do It For Their Own Personal Benefit.
Doctor's nowadays are generally just "blood test result readers and indiscriminate pill pushers". Need to leave the US if you want a real doctor.
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Re: Doctor's Do It For Their Own Personal Benefit.
If you know this is actually happening report them its a STARK violation and if found true the reportee will get %10 of the fines. DO NOT do this if you are not absolutely sure it costs the gov agency and medical community a lot in lost time and productivity raising the costs of services for false claims.
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To #22:
1) You are correct EHR systems have large upfront costs, and require maintenance and hardware throughout their life. At least at my company, all our clients have paid off their EHR's systems within three years, because of far better charge capture.
2 & 3) eRx is still new, but having a printer at your workstation/front desk print up all the Rx's for you is still a valid time saver.
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Prescription: Read this;repeat as necessary
Also, would it kill the MD to legibly write the name of the prescription to avoid any confusion. What do they accomplish by doing this? I have had several times with my doctor where the pharmacy has to call him to confirm the medication. A complete waste of my and their time.
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Computerized Physician Order Entry
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Printed Version
Previous doctors I have had have scribbled it down and the pharmacy has even had to call the doctor and ask what it was before. This could have led to the wrong prescription easily. Would be nice if all doctors did at least enter them into a computer and print them out.
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eRx is Moving - check out Surescripts.com
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Dr's and Computers
Very nice in my opinion.
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PocketScript
From the exam room, the doctor can prescribe any drug and send it to any pharmacy in the US. It may take a few seconds longer to write it on the handheld but the benefits outweigh any possible negative.
Doctors in private practice make money based on how many patients they can see in a day. The less time they have to spend on the phone with a pharmacy or an insurance company, the more patients they can see.
Doctors can see a patients insurance formulary right on the handheld or on the desktop. They know that when they prescribe for that patient, they won't be receiving a callback from a pharmacist who wants to make sure that an alternative is okay.
The patients like that they can go to their pharmacy and the script will be ready.
The insurance companies like it because they dont have to pay more for drugs that are not on formulary.
The docs like that they have instant access to a patients medication history without having to dig through a chart. They can also get trend information, find out how many of their patients are on a particular drug or print out a drug list for a patient.
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Way Overdue
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Can't nurses call it in?
Is this so hard? It's not any different than me handing the scrip to my pharmacist, with the additional layer of security because the nurse has to look at and read the scrip and can catch problems and mistakes as well as the pharmacist can. Beter, prolly, because the nurse has seen my chart and the pharm tech hasn't.
Once, when I was pregnant with my first child, I was prescribed a med for headaches that I took to my pharmacy. By the time I had gotten there, the nurse from the office had already called frantically telling them not to fill it, because it causes deformities in unborn children. The pharmacist told me that the nurse had noticed the problem when she was logging it all into my records. Thanks, nurse!
He was a reasonably good doctor, but he wasn't my regular doctor, he wasn't an OB/GYN and he didn't see that part of the chart. He made a small mistake that could have caused irreversible damage to my child.
Extra layers of people are good.
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it actually protects against fraud
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insurance coverage?
I think that largely though, the reason is going to be that they are accustomed to writing the prescriptions by hand. Tablet PC + spending time training software to recognize the quirks of their hand writing [plus having a nurse double-check it to give the patient a printed copy receipt while an electronic copy is sent to pharmacy - or an online prescription storage service, so that the patient can go to pharmacy of insurance company's choice to have it filled]
One of my family physicians had started using a small laptop in office, but typing - but this is his second year after finishing his residency, so adjusting to doing things in a different way is simpler than trying to re-learn 20+ years of a system of doing things.
I think the thought of 'must be hand-written' is based in the early 90s, before secure electronic prescription systems were developed as thoroughly, before most outlying cities had reliable affordable secured connectivity, with the thought of 'well, if it can be printed out at the office, then what is to stop a patient from duplicating it?'
I know that I have had the pharmacy randomly decide that they want to switch one of my medications in the past, because they didn't think the doctor had written it correctly [but he had, the tech just didn't know what he was specifying and didn't bother to phone to check]. I didn't have a clue, and ended up really unhealthy as a result for four months before we clued into my prescription being filled wrong - same medication, different formulation than it should have been. Pharmacy told me it was my fault for having 'uncommon medications' :(
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Talk to the pharmacy boards...
I've done some assessments for a company looking to implement telepharmacy services for a number of facilities, and the biggest problem that we had is that none of the electronic pharmacy systems in use would accept an authenticated/signed order from an external system, nor would the software vendors considering writing an interface for such a system. They all judged the risk of compromise and fraudulent orders to be too high.
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Doctor's script writing
In response to some of the comments, I would let you know that as a 56 year old MD I am using an electronic medical record. The interface is not the greatest but vastly better than anything I have looked at over the years. If we had adequate pen input or voice input that would speed acceptance by many physicians (as I sit here typing with two fingers).
Yet, I still write prescriptions by hand! If there were an electronic standard that all pharmacies used and I could email the script that would work well. As it stands the system has to fax the script and not all the pharmacies accept those well. Plus, as I am flying around the office trying to keep waiting times to the minmimum I don't always have time to go to a workstation and enter the prescription. The system does not yet work well enough to use while talking to patients and I refuse to sit staring at a monitor instead of making eye contact with my patient.
Finally, for those idiots who think that doctors belive themselves to be God...screw you. Try going to school and training for 8-12 years AFTER completing your undergrad degree (and having to bust ass then to get in to medical school), coming out with massive debt as most do, keep up with a rapidly changing body of knowledge, being under the pressure of malpractice lawyers and demanding patients who expect miracle cures for their imaginary ailments (probably some of the same dolts writing those comments) and try to be flexible and adaptive to every new trend that comes along.
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Re: Doctor's script writing
Listen, folks who develop script software, talk to this and other docs.
Speed is critical here.
Oh, and make damn sure your data is exportable because, as a TPA, we rely on this data. Putting a "DRM" on it only makes the product useless to the entire industry.
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Ready to read
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36 posts before...
New pharmacists in an area should always make sure they can recognise all the local quacks handwriting styles.
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Works great when it's done
it would seem that this system is even harder to abuse than paper prescriptions.
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Response from a doctor I know
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Press your doc to do it
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I remember being given one referral that looked okay (a little rushed maybe), but I ended up having the wrong test because one of the letters looked like a different letter. It wasn't harmful to me, thank goodness, but I see how a similar mistake on a prescription or other form could lead to a serious problem for someone else. Again, I'm not saying that electronics are foolproof or even faster, I'm just saying that should a doctor choose to hand-write, everyone (patient included) should be able to understand exactly what it says.
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Some limitations on this
That said, I go to a doctor who does this, and also prints it out - so there's little room for confusion.
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In America, a doctor's job is to minimize losses and maximize profits for the insurance companies. That's how HMO's work: Doctors only get paid when they DON'T treat patients.
HMO's "manage" health the same way DRM "manages" rights the same way prison "manages" freedom
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I feel your pain as to schooling and debt load when you hang the shingle out. I'm sorry, but some docs do have the holier than thou complex going on though. In the hall they can't speak (yes I did say hello to you), act as though they know more about electronics than I do (20 yr wireless veteran), and tend to bark orders (I ain't your operating room b*tch). These people tend to be WASPs in their mid 50's.
Here in Southwestern PA that's just the way they are. Unfortunately, they seem to represent you!
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Re: response
That being said, I don't want to be overly apologetic. The surgeons tend to be the worst, but the behavior you describe is very real, and very unacceptible.
Bottom line, we need standards in healthcare IT that allow for better sharing of information, better access to data, and real world solutions designed by people who use them. Maybe someday we will have those tools and the medical world will be a better place. Universal health care will be a driving force to make that happen, I hope. Combine that with more mid-level practitioners (FNPs and PAs) and I suspect that just maybe physicians will begin to see themselves as a part of a team finally, not the captains of some imaginary ship as some do now.
Thanks you responding thoughtfully.
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medicine
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Stupid doctors and greedy health insurance providers
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SomaGenix
Somagenix,a leading supplier of API’s and steroid hormone powders in Hong Kong. Our state of the art facility employs top chemical engineers and technicians while meeting quality assurance and compliance with North American and European standards. Our company allocates a substantial percentage of its investment towards Research and Development as we believe it is crucial in meeting market demands and innovation.
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Maybe some doctors suffer paranoia?
If there is any chance doctors are dishonest, this would be one reason for them to avoid writing prescriptions (and I am not saying that they are), as a doctor could be paranoid about it being scanned.
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