Hard Looks at Doctors’ Handwriting

compiled by Tenzing Terwilliger, Improbable Research staffwith instructive illustrations from the book Penmanship, Theoretical and Practical, Illustrated and Explained by Benjamin Franklin Foster, Souter and Law, London, 1843.

Doctors often find themselves the butt of jokes about their supposedly horrendous, illegible handwriting. These four studies suggest that, except in one department in one hospital in Indianapolis, Indiana, the reputation may be deserved.

Legible Handwriting in Indiana


“Deciphering the Physician Note,” E.A. Kozak, R.S. Dittus, W.R. Smith, J.F. Fitzgerald and C.D. Langfeld, Journal of General Internal Medicine, vol. 9, no. 1, January 1994, pp. 52–4 (http://dx.doi.org/10.1007/BF02599144). The authors, at Indiana University School of Medicine, Indianapolis, explain:

Objective information about legibility of physician handwriting is scant. This retrospective chart review compared handwritten general medicine clinic chart notes from internal medicine faculty and housestaff with their typed counterparts. The written counterparts took 11 seconds (46%) longer to read and 5 seconds (11%) longer to answer comprehension questions. The authors’ comprehension measure (developed specifically for ambulatory clinic notes) was only slightly higher for typed notes. The legibility of physician handwriting is not as dismal as assumed; physicians can effectively communicate on paper.


Illegible Handwriting in Scotland


“Reputation and the Legibility of Doctors’ Handwriting in Situ,” G.A. Cheeseman and N. Boon, Scottish Medical Journal, vol. 46, no. 3, June 2001, pp 79–80. The authors, at the Royal Infirmary in Edinburgh, report:

Our study evaluates if doctors deserve their reputation and investigates how legibility is affected by the time taken to write. Sets of in-patient hospital notes were selected at random. The first written entry by a doctor and a nurse in the current admission were analysed. In addition to this, 10 doctors and 10 nurses, unaware of the true nature of the study, wrote out lists of words and the time taken to do the task was recorded. The doctors’ handwriting was significantly less legible and they wrote significantly quicker. However a small minority of the doctors was responsible for the majority of illegible words written by that group.

Illegible Handwriting in Australia


“The Facts on the Legibility of Doctors’ Handwriting,” H. Goldsmith, Medical Journal of Australia, vol. 2, no. 12, September 18, 1976, pp. 462–3. The author writes:

A large number of people, both doctors and others, were tested. The handwriting of each participant was graded and four different statistical tests were performed on the results. In all of these tests the doctors’ handwriting came out significantly worse. Thus the only conclusion which could be established from these results was that doctors’ handwriting is indeed less legible than others.

Illegible Handwriting in Texas


“Legibility and Completeness of Physicians’ Handwritten Medication Orders,” E.H. Winslow, V.A Nestor, S.K. Davidoff, P.G. Thompson and J.C. Borum, Heart and Lung, vol. 26, no. 2, March–April 1997, pp. 158–64 (http://dx.doi.org/10.1016/S0147-9563(97)90076-5). The authors, at Presbyterian Hospital of Dallas, Texas, report:

OBJECTIVE: To assess handwritten medication orders for legibility and completeness, legibility of physician signatures, and presence of date and time the orders were written. SETTING: Three patient care units in one hospital in Texas. METHODS: Six experienced nurses evaluated medication orders and signatures for legibility using a rating scale developed for the study... RESULTS: Twenty percent of the medication orders and 78% of the signatures were illegible or legible with effort. Twenty-four percent of the medication orders were incomplete. Date was omitted on 18% of the medication orders, and time was missing on 58%.

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The article above is from the March/April 2008 issue of the Annals of Improbable Research. You can download or purchase back issues of the magazine, or subscribe to receive future issues. Or get a subscription for someone as a gift!

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