The Natural Connection

When I was five years old, after many months of struggle with a chubby lead pencil, I finally learned to write my name. All who knew me considered this a major accomplishment for a kindergarten student, and a sign of superior intelligence. In those days, all you were expected to do by the time you started first grade was to be able to memorize the words to a long song like Jumbo Elephant, draw a triangle, and get along with the kid sitting next to you on the big red sharing circle painted on the classroom floor. Parents never worried that Little Darling would miss out on a college scholarship if they couldn’t move files in Windows XP by the time they were three. 

On the very day that I could finally write my name clearly on a straight line, I was permitted to go to the downtown public library on a bus with all the other kids who were able to write their names, and get my very own library card. It was assumed that if you could at least write one word legibly, you would someday be able to read thousands of words written by others. Getting your own library card meant you could go downstairs to the Children’s Room and check out your own big print picture books, instead of staying upstairs with the grownups and the babies in the main library that reeked of moldy newspapers. 

I spent the next few years in Catholic elementary schools, where the nuns promoted us to smaller #2 lead pencils to practice our first printing. We were careful to make the capital letters and the small ones stay in between the blue ruled lines of the binder paper, and all facing in the right direction. Finally, the long awaited day came in third grade, when our teacher Sister Ruth sent our parents a letter announcing we should all come to class the next day equipped with a fountain pen and royal blue ink, as we would be “graduating” to cursive handwriting. “Ballpoint pens are forbidden”, the note read, “as they encourage sloppy handwriting”.

For months, I diligently practiced my handwriting after school each day, seated at my grandmother’s dining table. My Sicilian Nani supervised my efforts, to be sure I didn’t blob any royal blue ink on her lace tablecloth. “Nice”, my Nani said after one practice session. “Some day, after you marry a good Catholic boy from a rich Italian family, you will write beautiful Thank You letters for your wedding gifts.” When Sister Ruth awarded me a 5x7 gold certificate for Excellence in Penmanship, my Nani placed it proudly on her fireplace mantle in a gilt frame from Italy, planning to make it part of my wedding dowry, I suppose. 

Thanks to the efforts of Sister Ruth, and the legions of nuns that followed her, my handwriting remained legible for the next fifteen years or so. It was transiently corrupted by high school business teachers who thought that all young ladies would benefit from classes in Shorthand, so that those of us not lucky enough to marry rich Italian boys, Catholic or not, could at least find respectable employment as secretaries or “steno clerks”. 

Steno clerks were (always) women whose main job was to “take dictation” from their (always male) bosses, who mumbled so fast that their secretary’s only recourse was to scribble little snippets of letters into tiny spiral-bound memo pads. Among other things, a girl had to be able to wear spike-y high-heel shoes to be a steno clerk, and with my flat feet, I knew I was destined to fail miserably at that profession. Luckily for me, about that time, medical schools began to admit women, where it didn’t much matter what type of shoes I wore. 

What did matter in medical school, and later throughout medical training, was that I somehow be able to think, write, and speak, all at the same time, and in very rapid fashion. In the interest of efficiency, we were rewarded for mastering the skills of abbreviation in both speech and written communication. Within a few short years of beginning medical training, no one could understand a thing I or my classmates said, let alone decipher anything we had written. Besides, we were so tired from the long hours on the medical wards that we didn’t notice that we often dotted our T’s when our eyes were crossed from fatigue. 

When a 1999 report by the Institute of Medicine blamed doctors’ poor handwriting in part for medical errors, doctors and hospitals collectively sat up and took notice. Some prestigious hospitals, such as Cedars-Sinai in Los Angeles, offered handwriting refresher courses to their medical staff with good success. Other hospitals, perhaps overwhelmed at the task of teaching “old docs new tricks”, installed computerized medical records where prescriptions were entered by keystroke in an effort to reduce errors. 

The Federal Government has published a Medical Safety Fact Sheet to advise patients “When your doctor gives you a prescription, be sure that you can read it. If you cannot read your prescription, chances are that your pharmacist will not be able to either!”  Despite all these efforts, indecipherable or unclear prescriptions still result in more than 150 million calls a year from pharmacists to physicians asking for clarification of medication orders, costing the healthcare system billions of dollars a year in wasted time. At the very least, the process delays the time until a patient can receive their medication. In the worst-case scenario, a misread order can lead to patient injury or even death. 

I have my own personal spin on this. I don’t think it is unreasonable to require that physicians practicing medicine in America be able to not only read and understand the English language, but to write it legibly. Writing clearly in a straight line is something that we learned in kindergarten, and we can learn it again. Computer systems are nice, but cost millions of dollars, and it is just as easy to type a medication error as to write one. I’m personally in favor of the Cedars-Sinai Hospital approach. It would be a lot cheaper, easier, and probably safer, to give us all back our chubby pencils and blue lined paper, and lock us up for a few hours with Sister Ruth and her gang of nuns. 

For more information on Patient Safety, write to The Natural Connection, c/o Pauline Bellecci MD, PO BOX 777, Waycross, GA 31502 or contact us on our web site www.swampdocs.com

©2000-2003 Pauline M. Bellecci, MD