The Importance Of Penmanship For Medical Transcriptionists: Legibility Over Potential Legal Action

Charting

writing

We’ve all seen the scribbles after a visit to the clinic. Reading a prescription can be like trying to decipher which athlete’s autograph you got as a youngster.

But in the medical community, poor penmanship can lead to deadly consequences. Thousands of deaths in Canada are estimated annually because of medication-related problems, from incorrect dosage to the wrong drug being given altogether. It can happen more easily than most would imagine, with so many drugs available with similar names, but very different uses.

Even if those responsible for filling out prescriptions are as good a group of proof-readers as you’ll find in the medical community, the mistakes could come at a much earlier stage in the chain of care if a physician involved in the process is still relying on handwritten notes over transcribed medical notes from a professional medical transcription service.

Effective documentation during the lifespan of patient care — which is equally true in the hospital environment as it is in the clinic — is as important as the delivery of care itself. It allows all medical practitioners to instantly know a patient’s medical history, which is even more important now with multi-doctor clinic visits replacing the traditional ‘family doctor.’

The repercussions of inaccurate or incomplete records can be devastating for both a patient and physician.

Most mistakes typically go undetected until a negative outcome occurs, from misdiagnosis, to errors in treatment. Because of insurance through the Canadian Medical Protective Association, lawsuits in Canada are much more infrequent than in the United States, but they do take place. And beyond the potential for being held responsible for something as seemingly simple as illegible handwritten records is the potential damage to a physician’s reputation regardless of the outcome of a legal proceeding.

Medical dictation services, including outsourcing transcription services, can help ensure old and new records are legible, accurate and up to date to create the best patient care possible.

 

2Ascribe Inc. is a medical transcription services agency located in Toronto, Ontario Canada, providing medical transcription services to physicians, clinics and other healthcare providers across Canada. Our medical transcriptionists take pride in the quality of your transcribed documents. WEBscribe is our client interface portal for document management. 2Ascribe continues to implement and develop technology to assist and improve the transcription process for physicians and other healthcare providers, and recently introduced AUTOfax. AUTOfax works within WEBscribe to automatically send faxes to referring physicians when a document is signed off by the healthcare professional. As a service to our clients and the healthcare industry, 2Ascribe offers articles of interest to physicians and other healthcare professionals, medical transcriptionists and office staff, as well as of general interest. Additional articles may be found at http://www.2ascribe.com.

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