[subego]

Originally Posted by Oisín 

US doctors make their prescriptions by hand?

More like they do it however they want because no one is forcing them to do it the state's way.

My old doctor wrote them out, though he was the only doctor in his office, and was, um... old.

My new doctor enters them into a computer, but she's in an office with a half-dozen other doctors, so that probably defrayed the cost of the system.

Likewise, the hospital my old doctor was at was pretty run down, and the clinic my new doctor is at is connected to a hospital pretty flush with cash. They likely have the computers as part of being in that hospital's citywide network. Their scheduling system is entirely automated, etc.

[Oisín]

Originally Posted by subego 

More like they do it however they want because no one is forcing them to do it the state's way.

I don’t think anyone is actually forcing doctors here to do it the electronic way, either... but I can’t imagine many doctors who’d prefer the old-fashioned way over the smarter, new one. And certainly no pharmacy would.

[subego]

Originally Posted by Oisín 

I can’t imagine many doctors who’d prefer the old-fashioned way over the smarter, new one. And certainly no pharmacy would.

You saw the examples. Seems like less effort to me.

[Oisín]

Originally Posted by subego 

You saw the examples. Seems like less effort to me.

Not really, no. It would take most people a lot longer to scribble that (even illegibly) on a piece of paper than it would to type the first few letters of the name of the thing they want to prescribe (I’m assuming that’s how they write them in) and clicking ‘Submit’.

[subego]

Originally Posted by Oisín 

Not really, no. It would take most people a lot longer to scribble that (even illegibly) on a piece of paper than it would to type the first few letters of the name of the thing they want to prescribe (I’m assuming that’s how they write them in) and clicking ‘Submit’.

It's more than that. Most of the time there are various versions of the same drug (pill/liquid) etc., and then you have to tab over to fill out quantity and refills.

This is, of course, assuming you're logged in.

[wallinbl]

Originally Posted by ghporter 

Ever tried to read a physician's handwriting? With a mixture of latin-ish and abbreviations? Good luck. THAT is a huge part of the QC-making sure that the tech was even close is a tough call in some cases, and the pharmacist is responsible by law so he is often the one that talks to the physician when he can't read the scribble. We ARE talking about someone with a doctorate degree here, not someone with some 2 year vocational degree.Those are the TECHS. The (singular in almost all cases) pharmacist is the one that stays busy through lunch researching meds and calling doctors' offices.

Eh? They get paid that much money to read poor handwriting? Just have the doctor use a printer. I already pay too much for healthcare and medications. There's no point in prolonging an antiquated position, especially since it comes at a direct cost to everyone else. No one in this thread has made a case for why there is a pharmacist, let alone for why there is a highly paid pharmacist with an advanced degree. To tell you what the drug does? If your doctor didn't know, then why did s/he prescribe it? To tell you about interactions with other drugs? The doctor that prescribed it should have known about your other drugs before prescribing something in the first place. To count pills? My three year old can do that.

[Oisín]

Originally Posted by subego 

It's more than that. Most of the time there are various versions of the same drug (pill/liquid) etc., and then you have to tab over to fill out quantity and refills.

This is, of course, assuming you're logged in.

True.

Still, if the system’s properly done, I’d still think it’s faster.

Or at the very least easier than rewriting the entire prescription when the patient comes back and tells you that the pharmacy refused to accept the prescription ’cause they couldn’t read what it said.

(Yes, they will do that—or rather, they would do that, back when doctors still prescribed by hand, which was up till around 2000 or so, I guess. If they couldn’t easily read everything, they simply told you to come back when you had a proper prescription, rather than spend time trying to figure out if the doc wanted to give you 400 mg or 900 mg of whatshisdrug.)

[subego]

Originally Posted by Oisín 

(Yes, they will do that—or rather, they would do that, back when doctors still prescribed by hand, which was up till around 2000 or so, I guess. If they couldn’t easily read everything, they simply told you to come back when you had a proper prescription, rather than spend time trying to figure out if the doc wanted to give you 400 mg or 900 mg of whatshisdrug.)

Yuk.

In the situations where I've had this happen, the pharmacist just calls the doctor.

[Oisín]

They might do that in a small town where everybody knows each other anyway; but it’s the exception, not the rule. I guess they feel it’s not their job to run around cleaning up the doctors’ mess.

It did have the positive effect, though, that doctors would usually write fairly clearly when writing prescriptions (though not when writing anything else, of course).

[medicineman]

Permission granted. Do you need the decoder ring to go with it?

[Parvez]

Question: Does a Computer Engineer make more $$ than a Pharmacist? My mom wants me to go for Medicine, but I like computers

[subego]

Originally Posted by Oisín 

They might do that in a small town where everybody knows each other anyway; but it’s the exception, not the rule. I guess they feel it’s not their job to run around cleaning up the doctors’ mess.

For whatever reason, what popped into my head when I saw this was...

Look, little old lady, I don't care if you say he wrote insulin, I can't read it.

[ghporter]

Originally Posted by medicineman 

Permission granted. Do you need the decoder ring to go with it?

Yes, please. I can puzzle out a few things on some of them, but holy crap they're BAD!

I just did a clinical today in a facility that uses computer-based charting. Complain about the actual software all you want, but when 99.99% of the chart is PRINTED, that cuts way down on "WTF does this mean?" questions, whether it's "did the MD order an OT/PT eval, or did he say this patient should be an outpatient?" or "how often is Ms. Smith supposed to get hydrocodone, and how much is she supposed to get?" It was WAY easier here than at the "handwritten charts" facility I did my last rotation at. (By the way, I'm going to get a super-ultra-fine point pen for my own charting, no matter where I work-it looks like about half of the handwritten chart problems I ran into were caused by trying to fit everything into those stupidly tiny spaces on flowsheets.)

[Oisín]

(By the way, I'm going to get a super-ultra-fine point pen for my own charting, no matter where I work-it looks like about half of the handwritten chart problems I ran into were caused by trying to fit everything into those stupidly tiny spaces on flowsheets.)

Ah yes, another of life’s great mysteries.

Who was it that thought, “Let’s see... space to describe diagnostic measures, treatments, symptom development, plans for the patient, and complex medical descriptions of injury/illness... well, about 2 x 2 inches should be enough for that, shouldn’t it?” and then went on to make the apparently universal template for medical flowsheets without even asking anyone for a second opinion? A bloody idiot, that’s who.

If you think those cramped-iffy flowsheets are hard to read in person, try them once they’ve been faxed across the world. Cramped doctor’s writing—now in a staggering 5 ppi resolution!

[ghporter]

This is pretty much a matter of providing help for writing without providing such wide lines that you can't use the paper effectively. On a lot of chart forms there are lines like on notebook paper-make them too close together and the writing gets cramped, make them too wide and they writing is unconstrained and gets even sloppier than it would be for just being written to quickly. It's a balancing act that will never be perfect for everyone. Stick too many reminders and pre-formatted entry areas into a form and your writing guides get cramped no matter what. Leave them all off and things will be omitted because they are simply not obvious at the time the note is being written.

[abe]

They get drunk, misfill prescriptions with poison, smack around their underaged delivery boys and make up for it by buying them large steamer trunks and encouraging the youngsters to leave town on long ocean voyages.

[medicineman]

http://www.sparagus.com/members/rich/img022.jpg
The scribble at the extreme right means the doctor wants one month's worth of meds. Eight meds total.
1st - Cardizem LA 240mg - one daily
2nd - Crestor 5mg - one daily
3rd - Aldactone 25mg - one daily
4th - Plavix 75mg - one daily
5th - Niaspan 500mg - one daily at bedtime
6th - Hectorol 50mcg - two caps once a day
7th - Avapro 300mg - one daily
8th - Niferex Forte - one cap twice a day

http://www.sparagus.com/members/rich/img023.jpg
Cardec DM drops- 1/4 ml by mouth 3 times a day ... disp 30ml

http://www.sparagus.com/members/rich/img024.jpg
This is a decreasing dose of prednisone 10 mg.
Day 1 - take 5 tablets over the course of one day.
Day 2 - take 4 tablets - ditto
Day 3 - take 3 tablets - ditto
Day 4 - take 2 tablets - ditto
Day 5 - take 1 tablet
Dispense 15 tablets.

http://www.sparagus.com/members/rich/img025.jpg
1st - GyneLotrimin Vaginal Cream
disp 7 day supply - Apply vaginally daily for 7 days.
2nd - Doxcycline 100mg
disp 14 - take one tablet twice a day for 7 days.

[Person Man]

Originally Posted by medicineman 

(Impressive bit of interpretation removed).

I had a very hard time reading many of those prescriptions myself, and I'm a doctor. I'm also disappointed that they are still using abbreviations that are banned from use in hospitals by JCAHO. It's been my experience that one should change in all situations to avoid problems in one area.

In other words, using "banned abbreviations" outside the hospital where they are still "allowed" leads one to inadvertently use them in hospital situations where they are not allowed. It's easier to just change your practices across the board than try to remember where certain things are "allowed" vs "not allowed."

For those not in the know, I'm talking about the "O.D." as "once daily," or even QD as once daily. Too much ambiguity.

In my own prescriptions, I write out the word "daily" and spell out medicines fully instead of using abbreviations like HCTZ for hydrochlorothiazide. Sometimes the "Z" on the end gets mistaken for a "2" and the dose gets screwed up.

My handwritten prescriptions are done with "printed" letters vs. cursive, and while even my printed handwriting is not always neat, it is always legible. I'm always proud of the "F" grades I got in Bad Handwriting in medical school.

[cjrivera]

So you don't use TID, BID, etc.?

[el chupacabra]

they mix drugs, I just bought a bottle of cough syrup that the pharmacist mixed up. they fill capsules too and determine concentrations.

[ghporter]

JCAHO has "depricated with extreme prejudice" a lot of old, familiar medical abbreviations because of how easy it is to totally screw them up. For example, "OD" and "OS" for right and left eye seem to baffle enough people that JCAHO wants "right eye" and "left eye". Just forget about "ggts" for drops-apparently nobody studies enough history to be at all familiar with apothecary units.

OD, TID, BID, etc. have a long history of being easily misread (perhaps equal parts horrid handwriting and lack of ability to pick up the scribble through context), and were some of the early JCAHO casualties-at least in their "recommendations." Here is the "Official List" of banned abbreviations with their rationales, and a fact sheet about the issue. If you examine some of the rationales, it becomes pretty clear that chickenscratch is a major contributor to these decisions.

Eliminating easily misunderstood shorthand can't replace a good relationship between physician, pharmacist, and medications nurse in preventing medication errors, but it sure makes it harder to get into a situation where it could happen.

[Oisín]

OD and OS I can understand (oculus dexter and oculus sinister, I’m assuming). But what are ggts? Or TID/BID?

(I keep reading OD as overdosis, though)

[ghporter]

"ggts" are "drops" in apothecary measure. TID = "ter in die" or three times per day, BID = "bis in die" or twice per day, both from Latin. There is tons of bad Latin (and a bit of bad Greek) in medical terminology, and even more in medical shorthand.

[Oisín]

Originally Posted by ghporter 

"ggts" are "drops" in apothecary measure. TID = "ter in die" or three times per day, BID = "bis in die" or twice per day, both from Latin. There is tons of bad Latin (and a bit of bad Greek) in medical terminology, and even more in medical shorthand.

How does ‘drops’ come to be written ‘ggts’?


I wonder if medical shorthand is (more or less) the same all over the world, or if there are extremely varying styles. For instance, one of the most common phrases I see on medical reports (in English) from Spanish hospitals is variants on the theme “65m pt pr GA tr.con ad/x3”—does that even make sense to an American, or is it a purely Hispanoenglish thing? (Or even a purely Canary Islands hospital thing?)

[Peter]

speaking of short hand:

[Oisín]

^

[cjrivera]

FLK is actually commonly used term (not noted on charts, of course).
.

[medicineman]

The latin word for drop is gutta (guttae - plural), hence gtt.

[ghporter]

Originally Posted by cjrivera 

FLK is actually commonly used term (not noted on charts, of course).
.

You can't use it properly unless you've assessed for FLP* though. One of my profs is a peds specialist, and in discussing the NICU she pointed out the "range of normal" can be pretty broad. And every now and then you come up with an FLK. Sometimes that means there's a problem, sometimes it's "NFN."








Funny Looking Parents.

[cjrivera]

Of course. That's the first question that comes up when you mention that a kid is a FLK...
"Are the parents FLPs?"

[Person Man]

Originally Posted by cjrivera 

So you don't use TID, BID, etc.?

I use TID, and BID for now. But if they get banned, then I won't. I don't use QD or QID or OD or OS or OU at all.