Doctors’ Handwriting— Is It Really That Bad?

"According to conventional wisdom, doctors write in a code—a self righteous chicken scratch that is decipherable only by experienced pharmacists." Berwick and Winickoff conducted a study to determine whether physicians’ handwriting was really worse than other health professionals.1

Two hundred nine health professionals, including 82 physicians, who were attending a course on quality improvement in health care participated in the study. In 10 timed seconds they were asked to write the sentence, "Quality improvement is the best thing since sliced bread." The limited time was felt to impose the kind of time pressure under which busy people in health care operate. The writing sample was then scored for legibility on a four point (1-4) scale by four non-clinicians as "poor, fair, good, and excellent." A summary rating was calculated for each writing sample from the four ratings for each sample by adding the four individual ratings and subtracting these points from the total. This yielded a final legibility score between 1 (all four ratings being "poor") and 13 (all four ratings being "excellent"). The mean rating for the their group was 7.15 ± 3.14.

A total of 209 writing specimens were obtained, 82 from physicians, 32 from hospital chief executives and chief operating officers, and 85 from non-executive, non-physician health care workers.

The legibility score of the physicians was about the same as that of non-doctors: 6.67 vs. 7.46 (P = 0.074). The lowest scores were seen for the health care executives: 4.72.

The authors conclude that physicians’ handwriting is no worse than a comparison group of other health care personnel. They do recognize that the consequences of poor physician handwriting in medical records and prescriptions may be associated with greater hazard and so may be subjected to greater scrutiny.

If the danger and waste of poor physician handwriting is to be addressed, efforts to systematically improve communication with computerization and other innovations must be implemented, rather than pointing the finger at a profession whose "members, as a whole, write with an average hand."2,3—hap

References

1. Berwick DM, Winickoff DE. The truth about doctors’ handwriting: A prospective study. BMJ 1996;313: 1657-1658.

2. White KB, Beary JF. Illegible handwritten medical records. N Engl J Med 1986;314:390-391.

3. Mullen K. Importance of legible prescriptions. J R Coll Med Pract 1989;39:347-348.