Some doctors are defensive about their handwriting. Years ago we criticized prescriptions that patients could not read. One reader shared our column with her physician and got in trouble:
"I have never been able to read his handwriting so when you wrote a column about illegible Latin abbreviations I took it in almost as a joke and showed it to him. He exploded and told me that if I didn't like his handwriting I could damn well find another physician with perfect penmanship."
When doctors scribble prescriptions, pharmacists make mistakes. That's why patients sometimes get the wrong medicine or the wrong dose.
In one case, years ago, a patient with an earache was prescribed combination drops containing an antibiotic and a local anesthetic. They were to be given in the right ear, abbreviated r ear (no period). Three doses were administered rectally before someone figured out the problem.
Other examples are numerous. A pharmacy once filled a prescription for the diabetes drug chlorpropamide with the anti-psychotic medicine chlorpromazine. Had the diabetic patient actually taken the medication, he would have been too sedated to notice the blood sugar disturbance this medication can cause. The Institute for Safe Medication Practices (www.ISMP.org) has more examples.
One way to reduce misunderstandings between physicians and pharmacists is through e-prescribing. Doctors use computers or handheld digital devices similar to Palm Treos, BlackBerries or iPhones. When equipped with special software, the device allows a physician to send prescriptions wirelessly and securely directly to the selected pharmacy.
E-prescribing also does away with called-in prescriptions, which are also susceptible to misinterpretation. A busy pharmacy technician might well confuse the sound of Xanax with Zantac, for example.
Patients like the speed of electronic prescribing. When people are ill they would like to have their prescription waiting when they get to the pharmacy. The digital system can also alert doctors to mistakes. Most programs can catch potential drug interactions and dosage errors.
Some insurance companies offer doctors financial rewards to switch over to e-prescribing. In addition, the government itself is encouraging doctors by paying them for entering the digital age. Doctors who use the technology will get a bonus of 2 percent of their Medicare charges for 2009 and 2010.
Despite such incentives, it is estimated that only 12 percent of office-based doctors are currently prescribing medicines electronically. Patients may want to encourage their doctors to consider this step.
E-prescriptions will never be foolproof. Mistakes will happen, even with computers. That's why it is essential for every patient to request a printout of the prescription along with detailed instructions before leaving the doctor's office. When picking up the prescription at the pharmacy, the printout should be used to confirm the pharmacy has prepared the right drug at the right dose.
