We Doctors Forget: Computers Came Because We Couldn’t Write Legibly

So many people used to joke with me, “Do you guys have a medical school class in poor handwriting?”

Image for post
Image for post
Photo by rawpixel on Unsplash

Atul Gawande wrote an excellent article outlining the frustrations many physicians — including this one — have about electronic medical records. He wrote:

This is because — due to the many, many regulatory rules that apply to the healthcare field — as well as the multiple rules by multiple payers to be able to bill for our services, we are plagued by a multitude of computer clicks and steps before we can finish our work on a patient. Gawande highlights an example of how electronic medical records can cause such frustration among physicians:

This problem is one of the major factors leading to physician burnout, a serious crisis facing our healthcare system. NBC news recently reported:

I share this frustration, especially with subpar electronic medical records, or EMRs for short. At the same time, we physicians need to be honest with ourselves. With all the burdens on physicians that come with EMRs, we must not forget a big reason why they were adopted in the first place: physicians’ atrocious handwriting.

As Dr. Gawande wrote above, “Doctors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information — an entire two-page imaging report, say — rather than selecting the relevant details.” That’s true. At the same time, you can at least read the copy and pasted note on the computer screen. Very frequently, if not most of the time, you couldn’t read a physician’s handwritten note, no matter the length.

Back when I was in private practice, I would come across days and days of handwritten notes that I could not read whatsoever. After a while, I would just skip them and not waste my time trying to decipher another colleague’s chicken scratch. There may have been very important information contained in those notes. It didn’t matter, however, if I couldn’t read them.

Nowadays, among my other duties, I do some consulting work for hospital systems, and I come across physicians’ handwritten notes, sometimes very long ones, that are completely unintelligible. I am asked to render a judgment about the medical necessity of a hospital stay, and I can’t tell what is going on with the patient and what the physician wants to do with him or her. It is extremely frustrating.

In fact, it was a joke among non-physician friends and family members about doctors’ handwriting. I’ve lost count of the time people would say to me, “Do you guys take a class in poor handwriting in medical school?”

Now, I can’t share a copy of an actual medical record, as this would run afoul of patient privacy laws and is inappropriate. Thus, let me give an example of a fictitious patient note that I would write if I did not have an EMR:

Image for post
Image for post

My handwriting used to be neater than this, but as I have aged, my notes have become more and more brief and more and more sloppy.

It was not that long ago that I would overhear a unit secretary ask someone near him or her, “Can you read what this order says?” Sometimes, these orders would be for critical medications, and an educated guess could place a patient at risk.

In fact, it has been well documented that prescribers’ poor handwriting has led to medication errors. This fact led to the first foray of computers into hospitals: namely, CPOE or computer physician order entry.

It was definitely more work for us physicians, but it was absolutely the right thing to do. While a computer order entry system does not eliminate medical errors, it nevertheless eliminated the guesswork over which medication a physician wanted to prescribe due to illegible handwriting.

It was not long after CPOE came on the scene that electronic physician documentation in an electronic medical record followed. Again, more work for us — as Gawande’s article expertly noted — but at least you can read the progress note that was generated by said EMR.

While there are many great things about EMRs — and they have brought many benefits — this is not to say that EMRs are perfect. They are not. They have caused a tremendous amount of stress on a great number of healthcare professionals. This has to change.

At the same time, while it is true that the advent of EMRs was likely inevitable, we must never forget that it was us — and our horrific penmanship — that accelerated their arrival.

The opinions expressed in this post are my own and do not reflect those of my employer or the organizations with which I am affiliated.

Written by

NY Times featured Pulmonary and Critical Care Specialist | Physician Leader | Author and Blogger | His latest book is “Code Blue,” a medical thriller.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store