Handwriting and Efficient Communication.

[HighSpeed]

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This might be a touchy subject for some. However, it might also be an interesting topic for others. Now in the medical field the stigma out there is that doctors have bad handwriting. Commenting from an objective standpoint we can mostly agree that's exactly what it is, a stigma. You can certainly make a fair argument that there are docs with good handwriting and that their are docs with bad handwriting.

Now, that said, medical professionals (IMHO) always seek to do things better. In an effort to communicate better with peers, patients, others what do you, the reader, think medical professionals can do to practice more efficient written communication (handwriting to be exact). For you, the reader, please respond with your thoughts.

 

[trustwomen]

This might be a touchy subject for some. However, it might also be an interesting topic for others. Now in the medical field the stigma out there is that doctors have bad handwriting. Commenting from an objective standpoint we can mostly agree that's exactly what it is, a stigma. You can certainly make a fair argument that there are docs with good handwriting and that their are docs with bad handwriting.

Now, that said, medical professionals (IMHO) always seek to do things better. In an effort to communicate better with peers, patients, others what do you, the reader, think medical professionals can do to practice more efficient written communication (handwriting to be exact). For you, the reader, please respond with your thoughts.

My handwriting is chicken-scratchy but legible. I think the best way to solve this problem is electronic charting and prescriptions. We're getting there.

 

[Gotcha!]

This might be a touchy subject for some. However, it might also be an interesting topic for others. Now in the medical field the stigma out there is that doctors have bad handwriting. Commenting from an objective standpoint we can mostly agree that's exactly what it is, a stigma. You can certainly make a fair argument that there are docs with good handwriting and that their are docs with bad handwriting.

Now, that said, medical professionals (IMHO) always seek to do things better. In an effort to communicate better with peers, patients, others what do you, the reader, think medical professionals can do to practice more efficient written communication (handwriting to be exact). For you, the reader, please respond with your thoughts.

Type - everything is becoming computerized anyway.

So get those words per minute up.

 

[sdn1977]

Yes - many of us have writing that is difficult to decipher. But, part of it is learning the "lingo". I don't have trouble reading a medical chart or prescription (I'm a pharmacist) but that comes from years of reading them. But...I can't understand what my husband (a dentist) writes in his charts. Its completely understandable to his staff, but its all "greek" to me.

There are great advances out there like electronic charting & hopefully they'll be extended to the patient as well as the rest of us in healthcare. I already have one clinic which emails lab results & refill approvals to patients after they are reviewed by the physician. So...things will improve!

 

[HighSpeed]

Type - everything is becoming computerized anyway.

So get those words per minute up.

Gotcha, nice avatar by the way. Thats from "Office Space" isn't it?

Switching to electronic charting would be a general way to address the problem. History, however, history has taught us that the most effective change comes from the individual.

Websters Definition
Efficiency: the ratio of the output to the input of any system. In this context therefore, a more efficient written communication (handwriting) would mean one where the "comprehension" per "words written", or comprehension/words written, is higher.

Let's look at the scenarios:
Doctor A writes two sentences containing 20 words and the reader (maybe a fellow doctor, patient, or medical staff) comprehends only 10 of those words.

Doctor B writes the same two sentences containing 20 words and the reader comprehends 15 out of the 20 words.

Doctor B would be said more efficient in written communication (handwriting) than Doctor A because the person reading his sentences understood more words out of the total 20 that he wrote, hence comprehension/words written.

This issue, efficient written communication (handwriting), is one of the most important in the practice of medicine. With time we'll get many more responses. Meanwhile, give the issue a thought, and lets get another response from you.

 

[Gotcha!]

Gotcha, nice avatar by the way. Thats from "Office Space" isn't it?

Switching to electronic charting would be a general way to address the problem. History, however, history has taught us that the most effective change comes from the individual.

Websters Definition
Efficiency: the ratio of the output to the input of any system. In this context therefore, a more efficient written communication (handwriting) would mean one where the "comprehension" per "words written", or comprehension/words written, is higher.

Let's look at the scenarios:
Doctor A writes two sentences containing 20 words and the reader (maybe a fellow doctor, patient, or medical staff) comprehends only 10 of those words.

Doctor B writes the same two sentences containing 20 words and the reader comprehends 15 out of the 20 words.

Doctor B would be said more efficient in written communication (handwriting) than Doctor A because the person reading his sentences understood more words out of the total 20 that he wrote, hence comprehension/words written.

This issue, efficient written communication (handwriting), is one of the most important in the practice of medicine. With time we'll get many more responses. Meanwhile, give the issue a thought, and lets get another response from you.

This is a sort of old thread I'm bumping, and had forgot about.

My handwriting frankly sucks - In High School I had a teacher announce to the whole class that it is pretty much the worst he has ever seen - but that i'd probably end up a doctor

I think that tablet PCs might make this whole ordeal a lot easier, since inputs will now be electronic and transcribed to text.
I also think that the speed that doctors have to write their prescriptions, notes, and what ever else, detracts from their handwriting - reducing the communication as you put it.

You could make the argument that it isn't the handwriting that is the problem, but the fact that Doctors are rushed so much that they start writing like crap.
A huge leap for an argument, but i thought I'd throw it out there 😉

 

[LovelyRita]

I was going to discharge a guy tonight, he needs 14 days of IV vancomycin. He's medicaid. Anyway, I couldn't discharge him because I couldn't read the social worker's handwriting. I had four other people look at it. Nothing. So, since all this was after 5pm when the social worker was probably already home, he gets to stay another night in the hospital. Lovely. Your tax dollars at work.

Personally, I print large and clear. I feel that the medical record is no place for chicken scratch or hurried writing. You might as well write nothing at all.

 

[undertow]

Personally, I print large and clear. I feel that the medical record is no place for chicken scratch or hurried writing. You might as well write nothing at all.

Hell yea, I work at a pharmacy and i get to see some of the most horrid handing on scripts ever--some even on controlled drugs. It's like trying to decipher a secret code. So much time is lost trying to contact the MD to verify the hell he/she wrote.

 

[deleted87716]

Anyone would have bad handwriting if forced to write as much and as fast as most physicians have to.

Seriously. I used to do calligraphy. When I'm not in a hurry, my handwriting is extremely legible. It's only when I write fast (which is most of the time when I'm at work) that it can become a bit sloppy. It's still largely legible, however. And I do take pains to make sure my prescriptions are clear.

 

[fab4fan]

Doctors are not the only members of the health care team who have extremely hectic days. It's just that for so long they're been able to get away with illegible handwriting because others accommodated it one way or another.

I have absolutely no compunction stopping a doc/calling a doc back when I can't read orders. I't my license on the line, too. If I assume the order says one thing and it says another, I'm the one who gets in trouble if there's a med error.

If you are truly incapable of writing clearly, then at least try to print (although we have one doc can't even print legibly). Otherwise, expect a lot of calls from pharmacy and nursing to clarify your orders.

 

[deleted87716]

Doctors are not the only members of the health care team who have extremely hectic days. It's just that for so long they're been able to get away with illegible handwriting because others accommodated it one way or another.

Um...no. I can't read a lot of the notes that I get from home health nurses and physical therapists, either. It's not a "doctor thing." It's a "very-very-busy-and-must-write-a-lot-of-bull****-to-justify-my-billing" thing.

 

[fab4fan]

Sure, other people can have bad handwriting. One of the nurses I work with has atrocious handwriting.

But I can say after 21y of being a nurse that the most frequent offenders of sloppy handwriting are docs. Which would you rather have, though? To take a few minutes to slow down and write a tad clearer, or get paged frequently because someone can't read your notes/orders (or worse, have a med error occur because your careless handwriting was interpreted incorrectly)?

There is no defense for anyone to have unreadable handwriting. If you can't write longhand legibly, then PRINT. It's really not that difficult. If you can get through medical school, you can do this, too.

 

[deleted87716]

Which would you rather have, though? To take a few minutes to slow down and write a tad clearer, or get paged frequently because someone can't read your notes/orders (or worse, have a med error occur because your careless handwriting was interpreted incorrectly)?

Certainly you're not directing that to me, seeing as you've never examined a sample of my handwriting.

My handwriting is printing. I'm never careless. And I'm rarely asked for clarification.

As you noted, this isn't a "doctor problem." It's a human problem that will only truly be fixed when we change over to electronic medical records.

 

[fab4fan]

I meant "you"/"your" in the global sense, since, as you already pointed out, I haven't seen your writing to make a personal observation.

I'd be happy with just having orders that were entered by the docs electronically. We're light years away from that in my facility, unfortunately.

 

[Red Beard]

My state (Washington) recently passed legislation that makes it illegal for physicians to use cursive handwriting for writing prescritions. 👍
http://seattlepi.nwsource.com/local/274707_cursive21.html?source=mypi

Its not going to be long before they are all printed from a computer anyway.

 

[fab4fan]

My state (Washington) recently passed legislation that makes it illegal for physicians to use cursive handwriting for writing prescritions. 👍
http://seattlepi.nwsource.com/local/274707_cursive21.html?source=mypi

Its not going to be long before they are all printed from a computer anyway.

👍 👍 👍

 

[chocomorsel]

Have you guys noticed a difference between american doc's handwritting and foreing doc's handwriting. For the most part the foreign doc's handwriting is more legible than americans. That is because in other coutries, (at least in the countries in Africa where I'm from) we take classes in primary school where we learn how to write neat and nice. And those classes are graded. I cannot think of anyone in my family who has crappy handwritting. Most of the men write all neat and pretty you'd think it was a woman. I'm just saying. In america, handwritting is not emphasized in primary(grade school) like in Africa. The only way to fix this, is to start early. And of course with the advent of computers, that's gonna be a great help.
Just my 2 cents.

 

[QuikClot]

Those "neat writing" classes have been found to be ineffective in studies. Personally, I had a bunch in grade school and my handwriting is a train wreck.

Considering all the safety-conscious crap we do because one person screwed up and got sued, taking handwriting out of the equation should be a no-brainer. Typing should be the standard of care. Until then, I'll be printing.

 

[DNP student]

Doctors are not the only members of the health care team who have extremely hectic days. It's just that for so long they're been able to get away with illegible handwriting because others accommodated it one way or another.

Actually, I think other healthcare personnel get away with it much more than doctors do. Doctors are always getting slammed for their handwriting; in fact, it even makes the national news. However, very few nurses and therapists get dinged for their handwriting. In the most memorable legal case I was ever involved in, a nurse's charting was blown up to poster board size and put in front of a jury. The nurse was asked to read a few lines of the notes. Yes, it was 3 years later, but she couldn't read her own writing. Needless to say, this greatly influenced the jury and they found in the plaintiff's favor. That is something I have never forgotten.

 

[Llenroc]

I think most doctors write like ****e, to the point where their notes are largely garbage to anyone who may have to read them. Perhaps it's so because these notes are so infrequently read.

Also, many doctors are too quick to abbreviate anything and everything. And their abbreviations are not necessarily well understood by others.

The real problem is though that people in American hospitals are seen by too many people too frequently who all write a half a page or more. My Dad used to work in England, and said most in patients get seen once a day - if that - and about 4 lines are written.

 

[JourneyRn-MD]

I am looking forward to the day when computerized charting/orders makes its way to my unit! There is this nice big book of signatures that we keep at the desk to try and match to those left by the docs on their order so we know who just to call for clarification.... it is just as annoying for us to bug them as it is for them to be paged and it gets tiring on both ends after a while. As a nurse I am not totally immune to the bad handwriting stigma either- when I am rushing I can definately tell looking back over my writing...and I have to put forth the effort to make sure everyone can clearly read what has kept me running like a chicken with my head cut off!

 

[footcramp]

not having to fill out useless forms to cover my ass would be a start. joining the rest of the world with 21st century technology is another.

 

[OSUdoc08]

This might be a touchy subject for some. However, it might also be an interesting topic for others. Now in the medical field the stigma out there is that doctors have bad handwriting. Commenting from an objective standpoint we can mostly agree that's exactly what it is, a stigma. You can certainly make a fair argument that there are docs with good handwriting and that their are docs with bad handwriting.

Now, that said, medical professionals (IMHO) always seek to do things better. In an effort to communicate better with peers, patients, others what do you, the reader, think medical professionals can do to practice more efficient written communication (handwriting to be exact). For you, the reader, please respond with your thoughts.

This is why most medical records are electronic nowadays.

This is also why I write in "caps lock."

 

[fab4fan]

I am looking forward to the day when computerized charting/orders makes its way to my unit! There is this nice big book of signatures that we keep at the desk to try and match to those left by the docs on their order so we know who just to call for clarification.... it is just as annoying for us to bug them as it is for them to be paged and it gets tiring on both ends after a while. As a nurse I am not totally immune to the bad handwriting stigma either- when I am rushing I can definately tell looking back over my writing...and I have to put forth the effort to make sure everyone can clearly read what has kept me running like a chicken with my head cut off!

This is hilarious, but also a very good idea.

 

[RuralMedicine]

Doctors are not the only members of the health care team who have extremely hectic days. It's just that for so long they're been able to get away with illegible handwriting because others accommodated it one way or another.

I have absolutely no compunction stopping a doc/calling a doc back when I can't read orders. I't my license on the line, too. If I assume the order says one thing and it says another, I'm the one who gets in trouble if there's a med error.

If you are truly incapable of writing clearly, then at least try to print (although we have one doc can't even print legibly). Otherwise, expect a lot of calls from pharmacy and nursing to clarify your orders.

No doctors are certainly not the only members of the health care team with hectic days. I completely agree that when orders are illegible there is a great potential for medication errors and other untoward consequences. For this reason I print very legibly on notes, orders etc. When I get called because someone can't read my writing I know it's probably not my order (as a resident I'd get called because my pager # was legible a few pages earlier in the chart and the nurse "had no idea who even wrote the order to call"). Physicians are also unfortunately also not the only members of the health care team with illegible handwriting. It is frustrating when I can not read vitals or I&O documentation and it can also compromise patient care if I'm guessing what the blood pressure was or how well the diuretics are working. I've also gotten a few calls from pharmacy because they could not read the nurse's verbal order and were unsure what was being ordered. I've had a few verbal orders as well that I've spent more time trying to figure out what they said than signing.

 

[duckhunter25]

my handwriting sucks......thank god for dictation

 

[passatdream]

This is one major reason why Electronic Medical Records (EMR) are important to the future of quality healthcare.

And without wanting to sound too much like an advert, please see this thread for information about a scheme for expensive EMR Software to be given away free to medical students.

 

[NiteOwl]

My state (Washington) recently passed legislation that makes it illegal for physicians to use cursive handwriting for writing prescritions. 👍
http://seattlepi.nwsource.com/local/274707_cursive21.html?source=mypi

Its not going to be long before they are all printed from a computer anyway.

That would be horrible in my case, you can't read my cursive writing and I never use it (I haven't since high school when an occasional teacher would force us to use it), unless I am signing my name. My printed handwriting is much better. It looks kind of like chicken scratch, but you can read it. The computerized ways are cool though. I know a doctor that does this and it is great. At first he just printed the prescriptions off and signed them, but recently he has it set up to where he can fax the prescriptions directly to the pharmacy that you use.

 

[sdn1977]

That would be horrible in my case, you can't read my cursive writing and I never use it (I haven't since high school when an occasional teacher would force us to use it), unless I am signing my name. My printed handwriting is much better. It looks kind of like chicken scratch, but you can read it. The computerized ways are cool though. I know a doctor that does this and it is great. At first he just printed the prescriptions off and signed them, but recently he has it set up to where he can fax the prescriptions directly to the pharmacy that you use.

Actually...we're going toward having prescriptions electronically sent to us - not faxed, which many states have issues with when they are controlled substances. Altho it seems a simple thing to do....its actually quite complicated & requires a secure system & format to have happen. There is a task force of medical, legal & pharmaceutical folks working to have this become a standard with only one or two possible "languages" (I use this in the "programming" sense, which I don't know anything about myself).

Anyway...it will be great when it actually becomes a standard so prescribers know when they purchase a computer system with electronic prescribing capability, it will be uniformly accepted by all pharmacies.

 

[NiteOwl]

Actually...we're going toward having prescriptions electronically sent to us - not faxed, which many states have issues with when they are controlled substances. Altho it seems a simple thing to do....its actually quite complicated & requires a secure system & format to have happen. There is a task force of medical, legal & pharmaceutical folks working to have this become a standard with only one or two possible "languages" (I use this in the "programming" sense, which I don't know anything about myself).

Anyway...it will be great when it actually becomes a standard so prescribers know when they purchase a computer system with electronic prescribing capability, it will be uniformly accepted by all pharmacies.

Well, that is kind of what he does I guess. He sends it from the computer to the pharmacy. Maybe its faxed by computer/sent electronically. Not sure exactly how it works. If is is a controlled substance I know he has to give the patient a printed version, which he just prints off the computer and signs.

 

[caroladybelle]

..thank god for dictation

I hate to burst your bubble, lovie, but have you seen the printouts from the dictaphone lately????????

The US hospitals outsource (via telecommunication) much of medical dictation to India and other foreign (read lower paid labor) countries. And as a nurse, some of the mixups are hilarious.