IIb. Proposal 2- How to Avoid Prescription Medicine Mistakes

     How many times have you received a prescription from your doctor and said to yourself, “I hope the pharmacist can read this because it looks like Chinese characters”? There is a standing joke about the poor penmanship of physicians. However, this is no joke when it recklessly endangers a patient’s health.

     According to an analysis by the Institute of Medicine’s Committee on Quality of Healthcare in America, medical errors, including prescription errors caused by poor handwriting, might be partly or wholly responsible for 98,000 deaths a year. These medical error costs are in the billions of dollars. An analysis by the Institute for Safe Medication Practices stated,  
     “Virtually all of the prescriptions issued each year in the United States are written by hand. Indecipherable or unclear prescriptions result in more than 150 million calls from pharmacists to physicians, asking for clarification, a time-consuming process that could cost the healthcare system billions of dollars in wasted time. At the very least, that process can delay the time until patients receive their medications. At worst, a misread order can lead to injury or even death.”

     A number of commentators have suggested that physicians use electronic ordering tools to electronically transmit the prescription to the pharmacy. This suggestion has a number of weaknesses. First, the cost to equip all doctors and pharmacists with digital prescription ordering machines may be prohibitive and the cost will be passed down as higher physician fees, higher medical insurance premiums and higher drug costs. Second, authentication of the digital prescription has to be secure to prevent hackers from causing harm to the patient through mischief. The most important weakness in the use of a digital ordering system that is directly between the physician and the pharmacist is that it leaves the patient out of the loop. What we need is a secure electronic ordering information tool that enables the patient to be part of the loop.

     As stated in Part One, Maximizing Your Medical Advice, the patient must be actively educated about his or her medical care to be a successful patient. The patient should see the prescription, be able to read the prescription and question the prescription before leaving the physicians office. For example, if a patient has been treated for high blood pressure or high cholesterol, he or she will be familiar with the medication. If the prior medication provided for 10mg per day and the prescription says 100mg per day, the patient should immediately question the physician before leaving the office. In a digital ordering process between the doctor and the pharmacist which excludes the patient until the medicine is in the patient’s hands, the above mistake may not have been caught. Always look at the prescription before you leave the doctor’s office to make sure you can read it and understand what it is for. Ask the doctor to explain what the prescription is for and to clarify illegible handwriting. If your doctor is unwilling to explain and clarify the prescription, then get another doctor.

     A second proposal for change to our broken medical system, is to require all physicians to print or have office staff type the paper prescription. A hand printed prescription of 3 or 4 words and 1 or 2 numbers is not an unreasonable burden on physicians. In fact less cost will be associated with a printed prescription than a script prescription. The mandate to require printed prescriptions will require either legislation or state regulation by the medical licensing authority in the state. Significant monetary fines and warnings should be imposed on doctor’s writing script prescriptions. Two warnings will result in fines only, while a third infraction will result in a one week suspension of the physician’s medical license.

     This is a simple, no cost fix for a large physical, emotional and financial problem. All we need is the political will to mandate the use of printed prescriptions either by hand or machine and the cooperation of physicians. Since physicians take an oath to do no harm to their patients, this rule change should be readily accepted by physicians. 

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