White Paper

When I sat down to write the previous two blogs about Pencils and Pharmacy the single image I had in mind got lost in the shuffle. It was the 4 ¼ X 5 ½ inch white paper called an Rx or prescription; perhaps the last such hand-written note still in use in our daily life. Shopping lists are as ephemeral as poems written on napkins. Restaurant receipts, even dry cleaner stubs, are print-outs but prescriptions remain in much the same form as they did a century ago. They are actually legal documents, required by law to be retained from three to ten years.

So why are Rxs seemingly scribbled as if the doctor was breaking in a new pen? Is the writing deliberately careless or carefully unintelligible as if to preserve its arcane roots? It says to the patient, don’t ask questions, just do as you’re told. Even today an Rx preserves scraps of abbreviated Latin and a residue of its esoteric history. Most pharmacists can spot a forgery. The neat penmanship a dead giveaway; it lacks the authority and disdain for clarity of a true prescriber.

A prescription is a hot potato fraught with potential ambiguities. For example, Q.D. (one daily) can be read as Q.I.D (4 times a day) if the pen slides or a spec of lint lands and makes the dot between the Q and the D more than a dot. A grain (gr.) which is a measure from the apothecary system is easily confused with gram (gm.) from the metric system. The more I think about all this I seem to be getting a brain ache and I suddenly remember why I retired.

Some doctors have a habit of embroidering their Rx with redundant Latin phraseology such as misce et fiat which means mix and make where there is nothing to be either mixed or made, but simply counted. Liquid preparations still bear the old q.s. to indicate quantity. These are initials for quantum sufficit a medieval way of saying how many ounces. The signifier, Rx, is short for recipe, which means, take. The symbol is also claimed by astrologers and Greek scholars.

A patient hands me the white paper as I stand on a raised platform, as if a pedestal. From that angle, stationed between globes of colored water, I become a descendent of the brother/sister hood of shamans and alchemists. Instead of stirring a potion of plucked feathers, bark and berry I have merely to read the Rx and pluck the product off the shelf.

Every doctor seems to have his/her sui generis way of prescribing. Some have chicken scratching only a mother could love. Others have their own shorthand meaningless to any but the pharmacist in their building. My first prescription was written as P.B. I had no idea what that was. As I looked at it quizzically the patient said to me, Don’t you have any Phenobarbital? This was an abbreviation not recognized in academia. (It could just as well have meant, Pentobarbital). I received my initiation in the real world.

Whatever romance of the sorcerer is attached to a prescription written with a flourish there is an accompanying danger of misreading the name, strength or directions. It happened to me a few times though without grave consequences, I’d like to believe… or is that why some regular customers didn’t return? The pharmacist’s lot is not a happy lot, happy lot.

In this computer age more prescriptions are being transmitted electronically. At Kaiser-Permanenteas well as other medical facilities, all medical records including lab results and prescriptions are entered in their data base to be shared by every doctor and checked for contra-indications or duplications.

Soon every Rx will look the same; Ariel or New Times Roman. Much safer but much less collectible as an artifact of squiggly lines. A reasonable trade-off, I think. A time may come when archeologists in pith helmets will sift through ruins of ancient cities pulling out these curious odd white papers in scribbled glyphs.