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A Prescription Pad That Would Choke a Horse

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Dr. Marc Ringel

Technology has changed just about every aspect of everyday life especially where the medical field is concerned. But for KUNC commentator Dr. Marc Ringel, sometimes the old fashioned way of doing things still works the best.


Some people like taking medication.  Most don’t.  So, when I first make the diagnosis of mild hypertension I usually give a patient the choice of lifestyle modification to try to control her illness without drugs.  Some people take the opportunity to change.  Many do clean up their act some, though few succeed in lowering their pressure enough to avoid medication all together.  Nevertheless, it’s worth the try because controlling blood pressure is yet another reason and motivation to live a healthier life.

When I counsel a hypertensive I suggest that he decrease dietary salt and alcohol consumption, lose weight, and reduce stress, as well as exercise more and maybe increase dietary calcium and potassium.  As I explain these things I take out my prescription pad and write a single word to stand for each recommendation and pair the word with an arrow pointing either up or down.  Then I fill in the patient’s name and date, sign the prescription, and hand it over.

I choose to supplement oral instructions with this very simple written device rather than with a printed handout because I think my small one-pager is more powerful than a professionally produced, full-color, multi-page document that is chock-full of information about hypertension.  I do have fancy educational brochures to share and can also recommend articles, books and websites for people who want to inform themselves further about their illness.

But I count on the magic of the prescription pad, a major symbol of my power as a doctor to heal.  A single small page, filled with handwritten words and symbols, bearing the patient’s name and my signature, contains some strong magic.

Which brings me to the second point of this commentary, one I’ve touched on before.  It’s about what we are at risk of losing as we switch to an electronic medical record. 

Please understand that I am not arguing against taking advantage of the ability of information technology to record, check, transmit, and mine the megatons (actually terabytes) of patient data that we generate every day.  We just need to be careful, in automating medical record-keeping, that we don’t let the technology get in the way of the all-important healing relationship between patient and health professional.

Electronic prescribing is a terrific idea, especially for a legibility-impaired doctor like me who regularly gets calls from pharmacists and nurses baffled by my handwriting.  Systems that eliminate ambiguity, double-check for allergies and drug interactions, and do it all at the speed of light, are a huge step forward.

E-prescribing is catching on rapidly.  Many payers, especially the Feds, have built significant incentives that will take effect over the next few years, for clinicians to communicate electronically with pharmacists.

Great. But I plan to hang onto my analog device (i.e. prescription pad) and use it now and then when I need to make a certain sort of impression.  I suppose I’ll throw out the pad if written prescriptions become so passé that they have lost their symbolic power, which I don’t expect to happen soon.  To put it in perspective, which is more likely to get your attention, a platinum card with a credit limit of $100,000, or a fat wad of 100's that might only amount to $10,000?

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