Page 13 - Winter 2024 Bulletin

Reflections
Can I Read Your Chart? Can Anyone Read Your Chart?
S. Aaron Laden, M.D., M.B.A. nedalleumas@yahoo.com
Attorneys justifiably detest lawyer jokes, so it is reasonable to assume that physicians dislike jokes about the illegibility of doctors’ handwrit- ing. Whatever may be true of attor- neys, the question is: is it true that doctors have poor handwriting?
The explanations for why doc- tors’ handwriting may be substan- dard are several. One is the excuse
that doctors are pressed for time. Another is that much of the writing is done under
unfavorable circumstances
– standing while writing or
sitting with documents on their laps, writing on medi- cal charts in patients’ rooms, or writing on a too-small prescription pad.
Some have even gone so far as to attribute bad handwriting to the nature of medical school train- ing – that taking notes in class for many hours a day cripples the doctors’ ability to write clearly. We know that this idea is false because most medical schools have a note-taking service.
A more elaborate expla-
nation is that doctors write
in a special secret code un-
intelligible to their patients.
There is logic to this expla-
nation, but it, too, is false.
We, as physicians, know that there is nothing secret about how we write.
After all, how did doctors get the reputation for bad handwriting? The public was not privy to the hospital or of- fice chart with the S.O.A.P. format or the many abbreviations
used. Probably the most frequent opportunity for patients to see a doctor’s handwriting was the script on a prescrip- tion pad. Little does the patient know that the prescription contains a brand name or a generic name of a medication, and the rest is written in shorthand with Latin abbreviations. No wonder the writing looks bad; it is unintelligible to most people.
Why is the doctor’s handwriting important? I’m surprised you asked that question. Poor handwriting has been associ- ated with and has caused medical errors – patients given the wrong medication or the wrong dosage, for example. Some
errors result in incorrect diagno- sis. Omission or inability to read a simple word such as “no” may completely change the meaning of a note. “No chest pain” incorrectly written or read as “chest pain” can result in altered or incorrect test- ing and misdiagnosis. Further, poor handwriting wastes precious time for busy doctors, nurses, and other health professionals, time that could be better utilized for pa- tient care.
So, is it true that doctors’ hand- writing is worse than that of other professionals? Surprisingly, that study has been done. Berwick and Winickoff addressed this very question and published it in the British Medical Journal in 1996. In a study of handwriting samples from 209 healthcare professionals including 82 doctors, the authors concluded that “the handwriting of doctors was no less legible than
that of non-doctors.” (BMJ 1996;313:1657). These findings were supported by a subsequent study by Schneider et. al. in 2006 (Qual Saf Health Care, 2006 Dec;15(6):445).
The problem for those who still joke about doctors’ hand- writing is that, important as it once was, handwriting is no
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HCMA BULLETIN, Vol 70, No. 3 – Winter 2024
13