emPHAsis on the wrong sylLAble


Below is an entry in a chart from a patient that was sent to me.

From what I could read of the whole chart, it seems like the doctor who wrote this provides good medical care.

The issue is this: If the Medical Marijuana Advocates think that medicine is suddenly going to be saved from itself by forcing the entire medical industry to use some arcane set of rules when they write medications or medical orders, they’re wrong.

Stop putting the emPHAsis on the wrong sylLAble.

People are murdered with knives every day. We don’t make all the knives dull, we prosecute the people who misuse them.
Bad drivers kill and maim hundreds of people every day. We don’t force car manufacturers to put 2 foot cushions around the perimeter of the cars, we focus our attention on those people who drive poorly.
When lawyers file frivolous lawsuits we don’t …. nevermind, bad example.

Focus on the problem.

Don’t write “Q” before “D.” Don’t use “u” so it isn’t confused with “cc” – and by the way, you shouldn’t be using “cc” anyway, only “ml” … which shouldn’t be confused with microliter – ul. Don’t use “<” because some four year old might get it confused with “>” and don’t use “>” anyway because it might look like a “7” – or even a fancy “T” for that matter. Should we maybe just change the grade school textbooks to get rid of “<” and “>” altogether because some people aren’t smart enough to figure them out?

So let’s say JCAHO’s mandates are an overwhelming success. Everyone in the entire world … do they have a Medical Marijuana Advocates equivalent in Bucharest, I wonder …. anyway … everyone in the world only writes approved letters and makes sure that all decimal points are preceded by a “0.” Are all of these monstrous changes that have cost us millions of dollars to implement really going to improve the medical care provided by physicians with poor handwriting?

If there is an issue with certain physicians who write poorly, here’s a newsflash: Discipline the physician. Penmanship classes. Block letters. Typewritten orders. Make them hire a scribe. Ding ding ding ding ding. Win-win situation, here. Nurses actually understand the orders. Pharmacists can correctly fill prescriptions without flipping a coin. I don’t keep pulling my hair out from inane micromanagement.

Think there’s a lack of primary care physicians now? Do everything you can to make the job more appealing to those who know how to write like an adult. Keep all the useless picayune rules coming. Sit in conference rooms spending hundreds of thousands of dollars to see what hoops you’re going to make everyone jump through next, rub your hands together with an evil giggle, and couch everything in the name of “patient safety.”

While you’re at it, think about this: How safe will the patients be when there is no one left to care for them because you have helped make the practice of medicine so unappealing?


  1. I can’t even read the note the doctor wrote. You doctors sure have a way of writing and reading each other’s handwriting

  2. Holy crap, and I get told that my hand writing is bad. That’s just a series of squiggles. The only words I can make out are 4 er/…+2…8hrs…RA…not feet…R er…

    good luck with that one.

  3. I worked with that doctor, or his twin. His med orders actually caused me to think: what is the patient’s complaint?, what would be an appropriate drug?, does the dose correlate with the assumed med?. Once I figured it all out I went to the pharmacy and got what he wrote for.

    He was an excellent physician, too.

  4. Interesting post and I agree with you.

    Off topic a bit but I chuckle at physician signatures. I know you all are rushing and you pretty much seem to make your mark on the paperwork/scripts. One doc I know makes the equivalent of a slightly rounded check mark that I guess covers both names. The thing is no matter what names I apply to that mark…none of them could possibly be interpreted as a check mark including his. And regarding his…it would be the easiest to duplicate.

    I think of Zorro when I see my urodoc’s signature. He doesn’t have a z in his name but it always reminds me that Zorro was here. I guess I can see 2 of the letters in his name …sort of.

  5. Bostonian, you might have gotten more than I did, but I’m pretty sure the first part is “4 ea” as in four each.

    Then again, we could both be way off base.

    Whitecoat: Can you give us the answer to the question now teach?

    You’re asking ME? You need someone who has stayed at a Holiday Inn Express for this one.
    My best guess is that the first line says “x 2 days” at the end, the second line says “8 hrs 2 times” (?). Third line says “not better R eval per sister”? That’s about the best that I can do.

  6. I had good handwriting before I went to medical school. The fact that modern medicine thinks nothing of handing you a stack of papers to sign, typically on each page of something stating the obvious, quickly cured me. Fortunately JCAHO is here to address the core of the problem as always, which is trailing zeroes… not bureaucrats who think adding one more damned form will somehow ward off the lawsuit vampires.

  7. oh my god….YOU HIT THE NAIL ON THE HEAD!
    This made me angry just reading it. Not because you are wrong but because after having just gone through a JCAHO (wait that isn’t the correct alignment of letters it it? otherwise we have been pronouncing their name badly like jake-o) survery and spending hours HOURS going through charts and coming in early to go through charts to make sure cc’s weren’t written and that dc wasn’t written (even though now they supposedly allow it again?) just because of those stupid and inane rules. It’s not going to fix the problem, it’s just going to piss more people off. As a unit secretary and spending most of my day interpreting orders, I know the difference between CC and U and I also know when a doctor is being a jerk and just not writing properly. I wish I could scan some of my orders for you. Although that one you posted is pretty horrendous. I can’t even read most of it and that’s my job.
    Anyway…long comment to say you were spot on and kudos. Wish I could take this entry to JCAHO.

  8. Yes, exactly. I spent a lot of time as a medical student learning this arcane language, and now I want to use it. :) Our hospital, in addition to JCAHO rules, has some kind of people who are supposed to help the hospital code properly for all its/our services. They go around leaving notes on our charts about how we can’t write “[up arrow] K,” we have to say “hyperkalemia.” We can’t say “[down arrow] uo;” we have to say “decreased urine output.” Sorry, folks, I’m trying to write sixteen notes in two hours in the dark (because the hospital won’t turn on even low lights in the hallways till 6am), and I’m not going to triple the number of words I write because these coders aren’t allowed to make normal inferences.

    I enjoy your blog a lot.

  9. As a pharmacist I would not put it past some nurses or unit coordinators to think that MSO4 means mag sulfate instead of morphine sulfate. They just don’t have the chemistry background that MD’s or PharmD’s have in college. I do think the Joint does go overboard on some of the banned abbreviations but agree with most. I’m seen my fair share of near-misses due to staff trying to read an MD’s mind and/or poor handwriting. Oh, and the leading zero before a decimal and no trailing zero…..those are 10 or 100 fold errors waiting to happen. Saw a baby get 7 mls of ranitidine once, instead of 0.7 mls….the MD wrote it without the lead zero.
    Also….. I believe they are referred to as The Joint Commission now, we abbreviate TJC or just call them “the joint” where I work.

    Whatever you do, DON’T call it TJC. It might get confused with “TIC” and people might think that it is a bug that you have to pull from your skin and squeeze the blood out of. Or it might get confused with TJO Sports in Ohio. Or someone could mistake it as meaning >JC or “greater than Julius Caesar.”

  10. Pleeze……… I have zero tolerance for physicians writing orders like the one above. If they wrote legibly (what a novel idea) then there would be no need for the rules r/t abbreviations. I agree we should be able to continue to use them as I have for eons but there obviously have been safety issues that needed addressing. We all work long hours and if some efforts are made to create a safer environment for myself and my family when at the hands of our medical providers I rest better at night. Instead of complaining, come up with a better idea.

  11. “As a pharmacist I would not put it past some nurses or unit coordinators to think that MSO4 means mag sulfate instead of morphine sulfate. They just don’t have the chemistry background that MD’s or PharmD’s have in college.”

    I’m sorry, and it’s true, we don’t spent years studying pharm, but what we do know is enough that a mistake like that should NEVER be made. We do have to cover correct doses. BTW, I’m really hoping that whomever received that order got it clarified, and that it was not written too late in the day. I know a few MDs and DOs who write like that, and then get upset with a 0300 call to clarify. Lovely example of the hair-pulling things about healthcare, though! Wonderful Blog!

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