Why do doctors love Latin? No one has spoken this language in daily life for hundreds of years. And yet physicians insist on writing prescriptions with Latin abbreviations like hs (hora somni, or bedtime), po (per os, or by mouth) and qid (quater in die, or four times a day).
We have repeatedly encouraged health professionals to use simple, plain language, without abbreviations, in prescriptions and instructions to the patient. We were unprepared for the firestorm that followed.
One physician wrote: “Writing scripts in Latin, with a few exceptions, is necessary for precise information, communication, and saving time. Pharmacists are supposed to be trained in reading these scripts, and the scripts are written for the pharmacist to fill the prescription, not the patient.”
Although patients don’t fill their own prescriptions, they should be able to understand them. If the prescription is in code, how can the patient check that the proper medicine has been dispensed with the correct instructions?
One nurse vigorously defended doctors’ use of Latin abbreviations: “Pharmacists are having trouble reading symbols which have been used for years and years? I understand doctors’ handwriting is usually at the bottom of the barrel, but doctors do not have time to write every single word out extremely neatly. Doctors have agendas and busy days, and bad handwriting naturally accompanies that.
“Why aren’t pharmacists trained to read abbreviations like hs, po, etc? (Oops! That stands for ‘et cetera’… Oh no, that’s LATIN too!)”
Pharmacists are trained to translate Latin abbreviations into English. But they shouldn’t have to. Medical students are told to avoid abbreviations since these can lead to errors. The most authoritative text book of pharmacology admonishes, “directions to the patient should always be written in English. The use of Latin abbreviations serves no useful purpose.”
One pharmacist offered the following example: “Latin abbreviations are a source of problems when trying to decipher doctors’ handwriting. A pharmacy intern worked with us one summer. One day a customer came in the store and asked us why we typed ‘Take 1 tablet 4 times a day’ on his prescription for the diuretic Lasix. (He had been on this medication before.)
“We went to our files and retrieved the actual prescription. The doctor had scribbled ‘1 QD’ (1 tablet daily), but he put a period after the ‘Q’ and after the ‘D’ so the intern read this as ‘1 QiD’ (1 tablet 4 times a day). The period after the ‘Q’ looked like a small ‘i.’
“Pharmacists are absolutely overwhelmed with prescriptions, but it seems highly unlikely that this error would have occurred if the doctor had simply written out ‘1 daily.’ The doctor’s poor handwriting and use of a Latin abbreviation resulted in label directions calling for 160 mg of Lasix per day rather than 40 mg. Such an overdose could have had grave consequences if the customer had not questioned us.”
Lack of time is no excuse for scribbled Latin abbreviations. When pharmacists have to call doctors to verify an illegible prescription it wastes far more time than an abbreviation could save.
You might think that electronic prescribing (using a smart phone or a computer to submit prescriptions to pharmacists) would solve the problem It does eliminate the unreadable scrawl. But pharmacists have been telling us that electronic prescribing creates all sorts of other problems. In some cases an electronic prescription comes with automatic instructions that are part of the program. But a doctor may have verbally given the patient different instructions. This creates conflict. There is also the common problem of “alert fatigue.” This is when the computer tells the physician that two medications are incompatible, but the doctor overrides the warning. The pharmacist is now caught in a terrible electronic bind. To fill or not to fill the prescription?
The bottom line is that patients must get a printed version of every prescription in plain English and compare it to what is dispensed at the pharmacy. Always check to make sure your pills are in the correct dose and that you understand exactly how to take your medicine and what common side effects to be watching for.
To learn more about all of the mistakes that doctors make when prescribing and pharmacists make when dispensing, we recommend our just released paperback edition of the book, Top Screwups Doctors Make and How to Avoid Them. You will discover essential tips for protecting yourself and those you love.
