Writing & Error

Apropos the recent discussion on apology laws and medical error comes this lead from TIME Magazine:

Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion prescriptions written in the U.S. every year.

To address the problem—and give the push for electronic medical records a shove—a coalition of health care companies and technology firms will launch a program Tuesday to enable all doctors in the U.S. to write electronic prescriptions for free.

This raises a number of interesting points regarding language and medicine.  First is the seemingly self-evident notion that language matters in medicine.  Though this will seem obvious to any clinician who has ever bothered to take a patient history, it does not follow that all manifestations of the proposition (that language matters in medicine) are equally obvious. Thus, the second, and related point, that even the form of that language may contribute meaningfully to a given measured outcome, even a measured clinical outcome.  In part, the ethical model of literature and medicine posits that writing about illness can be therapeutic .  If this is so, and it seems plausible if not confirmed by randomized controlled trials,* then language, in both form and content, matters in clinical practice. 

For the physician, this TIME report neatly captures the notion that both the form the language takes (even "form" writ small, as in penmanship) and the meaning of the language (i.e., the wrong medication written down by the provider) as written measurably contribute to medical error.  Thus, though measurement is needed to assess the various ways in which language affects outcomes, it seems safe to suggest that this proposition has some merit without such evidence. 

Of course, as the article goes on to make plain, such a basic means of reducing error seems long overdue.  The article does draw one eyebrow-raising inference:

Thousands of people are dying, and we've been talking about this problem for ages," says Glen Tullman, CEO of Allscripts, a Chicago-based health care technology company, that initiated the project. "This is crazy. We have the technology today to prevent these errors, so why aren't we doing it?"

One of the reasons is that doctors haven't invested in the needed technology, so it's being provided to them.

(emphases added)

Thoughts?

*This is said with some irony.  I am well aware of the criticisms tendered against a somewhat uncritical acceptance of RCTs as the gold standard, superior in any potential epistemic investigation it could be deployed in.  RCTs obviously rest on an important evidentiary methodology, but there are some kinds of questions for which other kinds of methods -- especially qualitative methods -- would be superior.  See Jason Grossman & Fiona J. McKenzie, "The Randomized Controlled Trial: gold standard, or merely standard?" Perspectives in Biology and Medicine Vol. 48, no. 4 (2005): 516-534.