Why Do Doctors Still Write Prescriptions (Illegibly) When They Can Type Them?

from the seems-simple-enough dept

Reuters is running an article talking about how folks in India are urging doctors to stop writing prescriptions so illegibly, as it all too often leads to filling the wrong prescription (even to the point of putting someone’s life at risk). However, this is hardly just an Indian issue, as the same thing happens in the US as well. In an age where more and more doctors’ offices are computerized, it simply doesn’t make any sense not to offer computerized prescriptions that accurately display the drug in question (including, perhaps, questions or warnings about possible conflicts or side effects). The fact that it may save a few seconds for a doctor to scribble hardly seems like a reasonable excuse when people’s lives are on the line and it’s part of the doctor’s job to do whatever possible to keep them healthy.

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Comments on “Why Do Doctors Still Write Prescriptions (Illegibly) When They Can Type Them?”

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PaulT (profile) says:


For a profession where they have to keep up with new research, medicines and other issues constantly, some doctors can often be lazy luddites when it comes to new technology outside of their chosen field. I’d be willing to bet it’s the older generation of doctor who have this aversion to printing off a prescription, probably the same ones who object to the computerisation of their offices.

William C Bonner (profile) says:

My Doctor Electronicly transfers the script to my drugstore of choice

When I get a prescription from my doctor, he sends it electronicly to my drugstore. This does multiple things that are good, and I don’t want to think about the bad possibilities right now.

1. The prescription goes to the drugstore in a legible format.
2. The prescription arrives at the drugstore before I do, reducing my waiting time.
3. The prescription arrives at the drugstore, and doesn’t get lost in my car, or blown out the window, or put off till later, and lost with other paperwork.
4. If there was a problem, or it went to the wrong store, I can call up my doctors number, and a tech can re-route it to the correct store. (This is mostly useful for recurring prescriptions conflicting with my own forgetfulness and travel needs)

BlogReader says:

Why should doctors have to type?

They’re busy saving lives!

The reason docs don’t type this up as it will take them longer and they view it as someone else’s job. This is like asking Moses to type out the 10 Commandments after he’s given them too you.

And honestly the UI to enter in this stuff is painful. Why should a doctor have to figure out the UI to enter in a drug when he already knows it? Instead we force them to select “Levotol” from a dropdown list, then a dropdown list of what size to give the patient then a combo box to select how long, etc etc.

The doctor just wants to get things done and writing out “300mg Levotol” is the fastest thing. Maybe if the UI of medical apps caught up with that more doctors would type it in (or more likely use speech to text, if they didn’t have to correct it).

mobiGeek says:

Re: Why should doctors have to type?

Though I can see room for an argument against doctors being forced to use a computer (not educated enough??), I don’t buy that the process should not involve a computer being used.

The argument that they are “too busy saving lives”?? I mean, are they in a war zone? An extra 2 minutes per patient is not going to bring down their daily average of viewed patients.

If the doctor isn’t willing to use newer technologies (everyone knows that medicine reached its pinnacle of knowledge when the ballpoint pen was invented), then get someone else to input the information but the prescribing doctor should be confirming the entered data.

Grant Hamilton says:

Re: Why should doctors have to type?

As a doctor, I can tell you, this is EXACTLY the reason. We had a presentation a couple of years ago from some IT person who was trying to sell us on the idea of why typing in the prescription was so much better. She’s clicking through about 40 PowerPoint slides showing us all the different steps and dropdown lists and one of our faculty asks her to demo writing a prescription for Tylenol. So she logs in, types in a medical record number, chooses the Meds tab, and types in Tylenol. A list of about 400 variations pops up (liquid, tablet, suppository, Tylenol with codeine, Tylenol with hydrocodone…). Everyone in the room starts chuckling and she gets a little offended and says that she doesn’t understand what is so funny. And THAT is the problem. The people who design these systems never have to use them.

Twinrova says:

I can tell you exactly why drs don't use computers

I work for a TPA in the medical industry and this blog hits directly home.

Doctors and computers mix like water and oil. With a patient load, doctors don’t often have the time to sit down and use a computer, thus, it’s faster to write it out.

Moreso, doctors often aren’t trained properly in the use of the program to which they’re supposed to use and this too leads to the dismissal of technology.

In many clinics, it’s usually left to office personnel to “fill” the prescription, even going as far as setting it up to the patient’s pharmacy.

This is no different than a patient not looking at the prescription to determine if they can read it, which would be the first indication of a possible problem.

Anonymous Coward says:

I worked as a pharmacy tech back in high school. I absolutely hated trying to read hand-written prescriptions when putting them in the computer. I couldn’t even read it most of the time. So, I usually just gave them a bottle of oxycontin and sent them on their way.

Just kidding… but seriously some doctors suck at writing. I think it’s a game of wits they place with pharmacists or something.

Jake says:

Filling out a short form like that isn’t significantly faster or more convenient with mouse and keyboard than with a biro, and electronic transmission invites all sorts of potential security problems. Besides, just taking a reasonable degree of care with one’s handwriting should solve the problem, as would pharmacists telephoning the doctor’s surgery to double-check if they weren’t certain.

Dr. Dave says:

not just prescriptions

Some doctors writing just in plain suck. Not just on prescriptions but try reading an entire note made up of squiggly lines. And this is where I think that most of the problems started. If you have to write a page and a half note on 10 patients and you then have to get to your office where you have another 30 notes to write you start writing faster and get lazy. And this carries through all of their writing. I was always told how bad my writing was but now nurses compliment me because compared to some people I write amazingly well. And it is because of this that ALL hospitals will have to switch to computer based records. But BlogReader is right and some of the software out there is horrible. I don’t know why any hospital would buy it unless it is about the kick backs.

John says:

Doctors scribble illegibly on prescription pads because they don’t know the exact spelling of the drug and don’t want to be embarrassed by a mere pharmacist. The pharmacy will always call the doctors office anyways to confirm that the doctor wrote the prescription and what it was for. A prescription pad is hardly a secure document and could be easily forged.

takeaswag says:

My primary care doc (an older guy) retired and sold the practice to a younger lady doctor. What was the first thing she did? Computerized the office of course. then there’s my periodontist. A fourty-something guy. Decided to fully computerize the office (X-rays and all). His motto throughout the changeover was “Training, Training, Training.” It worked. Now everywhere I go (even the emergency room) if I need a script it is printed. Have never asked iof it could be electroically transmitted, have to do that next time. I do know that the drug list they are presented is customized for my insurance.

Anonymous Coward says:

I am a developer at an EHR software company. In our software (and all other EHR software, I assume), medication orders are placed in the software and Rx’s are either printed off or sent via fax or eRx to a pharmacy. The only thing holding doctors and medical centers back is their own adoption of EHR systems. It is faster that hand writing the Rx, because it is a natural byproduct of documenting the patient visit in the EHR. Some doctors don’t like recording their visits in the EHR, but often do not have a choice (practice policy).

Anonymous Coward says:

Lot of misinformation here.

1) For private or even small group practices, it costs a lot of money to upgrade to EMRs (electronic medical records) which you need to write electronic scripts. It then also costs more money to “add on” the ability to electronically handle scripts

2) Not all managed care companies are up to speed on handling electronic scripts.

3) Not all pharmacies are up to speed on handling electronic scripts

But we need to go back to #1 – it costs MONEY. And in today’s age with very low reimbursement rates for doctors, high malpractice and insurance costs, electronic scripts ARE NOT COST EFFECTIVE.

Some states have laws about illegible scripts – that should help some. Consumers need to be more aware of what they are taking and check the script they recieve from the pharmacy.

Sean says:

Re: Re:

1)It does cost money but you do not need an EMR to print or send the scripts several companies have web based ones or stand alone programs to do this even for use on a PDA.

2)I guess they cant read (electronic = print)

3)Ok for this one I will take electronic as electronically transmitting. The large places have it set up to receive them now the smaller ones are currently able to receive by fax as an alternative. In 2010 they will not be allowed to receive them in this way and will have to convert or go out of business.

Hippocrates says:

Doctor's Do It For Their Own Personal Benefit.

It’s because if it was typed, then you could read it and get it filled on line, and the doctors would not get their kickbacks from the local pharmacy who pays half their rent.

Doctor’s nowadays are generally just “blood test result readers and indiscriminate pill pushers”. Need to leave the US if you want a real doctor.

Sean says:

Re: Doctor's Do It For Their Own Personal Benefit.

“It’s because if it was typed, then you could read it and get it filled on line, and the doctors would not get their kickbacks from the local pharmacy who pays half their rent”

If you know this is actually happening report them its a STARK violation and if found true the reportee will get %10 of the fines. DO NOT do this if you are not absolutely sure it costs the gov agency and medical community a lot in lost time and productivity raising the costs of services for false claims.

Anonymous Coward says:

#20 here.

To #22:

1) You are correct EHR systems have large upfront costs, and require maintenance and hardware throughout their life. At least at my company, all our clients have paid off their EHR’s systems within three years, because of far better charge capture.

2 & 3) eRx is still new, but having a printer at your workstation/front desk print up all the Rx’s for you is still a valid time saver.

too illegible to read says:

Prescription: Read this;repeat as necessary

Why not have a pharmaceutically-knowledgeable person working behind the reception desk that you would hand you’re hand-written prescription to, that would do the “high-tech” task of sending it electronically to the nearest pharmacy of choice.
Also, would it kill the MD to legibly write the name of the prescription to avoid any confusion. What do they accomplish by doing this? I have had several times with my doctor where the pharmacy has to call him to confirm the medication. A complete waste of my and their time.

Evan @ WebMD says:

Computerized Physician Order Entry

So there is a push toward Computerized Physician Order Entry. Organizations like the Leapfrog Group are scoring hospitals across the country on (among other things) weather or not the facility uses CPOE. this is a definite trend in medicine right now, and I suspect before too long it will become an issue at the individual MD practice level. Patients Grasshopper 🙂

erica (user link) says:

Printed Version

I love the way my current doctor does prescriptions. They are entered into a computer, printed out and then handed to me to take to the pharmacy. This is the first doctor I have had that does this.

Previous doctors I have had have scribbled it down and the pharmacy has even had to call the doctor and ask what it was before. This could have led to the wrong prescription easily. Would be nice if all doctors did at least enter them into a computer and print them out.

PhilMichigan (user link) says:

eRx is Moving - check out Surescripts.com

No 6 pointed to an organization working towards this. See
They report 35,000,000 electronic prespections last year and they are forecasting 100,000,000 this year. Sounds like good progress to me. I am happy to see that Michigan is ranked number 6 in the nation for use of this standard.

Anonymous Coward says:

My doctors have small laptops they carry around. I get visit card when I check in and verify my insurance. I can fill out my forms on a computer or hand write them (which get’s keyed by the clerk) I go to my doctors office after that scan the card which at the receiption desk and wait for my name to be called. Doctor/nurse scans the card enters in the medical information and enters in the script and either sends it to my drug store or prints it out. Lab/Radology/etc give them the card and they know what needs to be done. Return the card the cashier and pay my deductible. My scripts are unsually filled by the time I get to the drug store. I like it seems convienent, but these are young Doctors, the cool thing is their system allows them find new meds and alternative or new drug issues right then and there. As well as providing them a history or scripts if an issue arises and they can call and tell me to stop taking the script.

steve says:

Dr's and Computers

My doctor has just now started packing around a ultra-light computer as he goes from room to room to see patients. I’m assuming medical records are on there and when he prescribes something he types it in right there, leaves the room and comes back with a printout of the prescription.

Very nice in my opinion.

Joe Hufford says:


I work as a contractor for ZixCorp. What I do is set up a wifi access point and a wifi enabled PDA that runs an app called PocketScript.

From the exam room, the doctor can prescribe any drug and send it to any pharmacy in the US. It may take a few seconds longer to write it on the handheld but the benefits outweigh any possible negative.

Doctors in private practice make money based on how many patients they can see in a day. The less time they have to spend on the phone with a pharmacy or an insurance company, the more patients they can see.

Doctors can see a patients insurance formulary right on the handheld or on the desktop. They know that when they prescribe for that patient, they won’t be receiving a callback from a pharmacist who wants to make sure that an alternative is okay.

The patients like that they can go to their pharmacy and the script will be ready.

The insurance companies like it because they dont have to pay more for drugs that are not on formulary.

The docs like that they have instant access to a patients medication history without having to dig through a chart. They can also get trend information, find out how many of their patients are on a particular drug or print out a drug list for a patient.

Rose M. Welch says:

Can't nurses call it in?

I always ask that my scrip be called in to my pharmacy so it’s waiting for me when I get there. The doc hands the written scrip to the nurse (or other office personnel, as I can’t be sure that she’s a nurne, no nametag, even the office manager wears scrubs), who’s used to his handwriting, who then calls it in.

Is this so hard? It’s not any different than me handing the scrip to my pharmacist, with the additional layer of security because the nurse has to look at and read the scrip and can catch problems and mistakes as well as the pharmacist can. Beter, prolly, because the nurse has seen my chart and the pharm tech hasn’t.

Once, when I was pregnant with my first child, I was prescribed a med for headaches that I took to my pharmacy. By the time I had gotten there, the nurse from the office had already called frantically telling them not to fill it, because it causes deformities in unborn children. The pharmacist told me that the nurse had noticed the problem when she was logging it all into my records. Thanks, nurse!

He was a reasonably good doctor, but he wasn’t my regular doctor, he wasn’t an OB/GYN and he didn’t see that part of the chart. He made a small mistake that could have caused irreversible damage to my child.

Extra layers of people are good.

amalyn (user link) says:

insurance coverage?

Some coverage policies in Canada specify that prescriptions, especially for controlled substances, must be hand-written.

I think that largely though, the reason is going to be that they are accustomed to writing the prescriptions by hand. Tablet PC + spending time training software to recognize the quirks of their hand writing [plus having a nurse double-check it to give the patient a printed copy receipt while an electronic copy is sent to pharmacy – or an online prescription storage service, so that the patient can go to pharmacy of insurance company’s choice to have it filled]

One of my family physicians had started using a small laptop in office, but typing – but this is his second year after finishing his residency, so adjusting to doing things in a different way is simpler than trying to re-learn 20+ years of a system of doing things.

I think the thought of ‘must be hand-written’ is based in the early 90s, before secure electronic prescription systems were developed as thoroughly, before most outlying cities had reliable affordable secured connectivity, with the thought of ‘well, if it can be printed out at the office, then what is to stop a patient from duplicating it?’

I know that I have had the pharmacy randomly decide that they want to switch one of my medications in the past, because they didn’t think the doctor had written it correctly [but he had, the tech just didn’t know what he was specifying and didn’t bother to phone to check]. I didn’t have a clue, and ended up really unhealthy as a result for four months before we clued into my prescription being filled wrong – same medication, different formulation than it should have been. Pharmacy told me it was my fault for having ‘uncommon medications’ 🙁

Kevin says:

Talk to the pharmacy boards...

I know that in most states what constitutes a valid prescription is determined by the state board of Pharmacy. In Ohio, for example, the dispensing pharmacist has to have “positive ID” from the dispensing physician. According to the rules of the pharmacy board, that means a hand-written signature. In hospitals that use electronic ordering they can submit an order via a computer, but the physician has to “sign” the order with a fingerprint scan. This works well within a single hospital or a group of facilities owned by the same organization, as they can ensure compatibility between the various systems and can process the electronic orders and signatures. But when you’re dealing with disparate hospitals, physician offices, and pharmacies, making all of the systems talk can be difficult if not impossible.

I’ve done some assessments for a company looking to implement telepharmacy services for a number of facilities, and the biggest problem that we had is that none of the electronic pharmacy systems in use would accept an authenticated/signed order from an external system, nor would the software vendors considering writing an interface for such a system. They all judged the risk of compromise and fraudulent orders to be too high.

wkr md says:

Doctor's script writing

It is always interesting to hear non-medical people discuss what they think is going on in a physician’s mind and how they think we should behave and function. It is truly sad that we cannot share our experiences with others so that they might “walk in our shoes”.

In response to some of the comments, I would let you know that as a 56 year old MD I am using an electronic medical record. The interface is not the greatest but vastly better than anything I have looked at over the years. If we had adequate pen input or voice input that would speed acceptance by many physicians (as I sit here typing with two fingers).

Yet, I still write prescriptions by hand! If there were an electronic standard that all pharmacies used and I could email the script that would work well. As it stands the system has to fax the script and not all the pharmacies accept those well. Plus, as I am flying around the office trying to keep waiting times to the minmimum I don’t always have time to go to a workstation and enter the prescription. The system does not yet work well enough to use while talking to patients and I refuse to sit staring at a monitor instead of making eye contact with my patient.

Finally, for those idiots who think that doctors belive themselves to be God…screw you. Try going to school and training for 8-12 years AFTER completing your undergrad degree (and having to bust ass then to get in to medical school), coming out with massive debt as most do, keep up with a rapidly changing body of knowledge, being under the pressure of malpractice lawyers and demanding patients who expect miracle cures for their imaginary ailments (probably some of the same dolts writing those comments) and try to be flexible and adaptive to every new trend that comes along.

Ben says:

36 posts before...

… anyone pointed out the main reason for sticking with hand-written prescriptions. It’s so that the pharmacists can recognise a fraudulent prescription for Viagra or some other expensive (black-market saleable) drug.

New pharmacists in an area should always make sure they can recognise all the local quacks handwriting styles.

Jesse Crawford (user link) says:

Works great when it's done

I’m with Kaiser Permanente, and they manage prescriptions completely automatically. When your doctor prescribes a medication, the prescription is stored with your medical record (presumable on a server deep inside the Kaiser Permanente corporate headquarters, perhaps even guarded by ninja monkeys) and then you can just give the pharmacist/assistant your card and they can pull up all your prescriptions at once. The computer system also keeps track of who prescribed it (obviously)when and where it’s been filled and refilled. You can, of course, request a paper version to take to a non-Kaiser pharmacy.

it would seem that this system is even harder to abuse than paper prescriptions.

Blaise Alleyne (profile) says:

Response from a doctor I know

“Well, we don’t often have computers with us in the room and a signature is required even after it is printed off, which actually takes longer but more importantly, prescriptions are often written on duplicate paper to prevent fraud and so the computer systems would have to have a record that could be absolutely locked so that the tracking and duplication are easily seen.”

Sicko says:

Press your doc to do it

Until we insist our doctors do it, they won’t. Make a fuss at your doctor’s office. Ask them to tell you why they can’t do it, even if it costs them their extra SUV or condo in Florida. Then insist that the secretary retype your script on that selectric typewriter and make them spend time to get it right. Insist on being able to read it yourself.

Celes says:

Personally, I have no problem with a doctor choosing handwritten prescriptions and forms over electronic ones, as long as they are legible. The problem is, especially with afternoon appointments, the poor doctor has been frantically writing for hours and the writing becomes less and less legible as a result. And having to rewrite something, I would assume, would take more time than just doing it a different way the first time.

I remember being given one referral that looked okay (a little rushed maybe), but I ended up having the wrong test because one of the letters looked like a different letter. It wasn’t harmful to me, thank goodness, but I see how a similar mistake on a prescription or other form could lead to a serious problem for someone else. Again, I’m not saying that electronics are foolproof or even faster, I’m just saying that should a doctor choose to hand-write, everyone (patient included) should be able to understand exactly what it says.

Anonymous Coward says:

Oh, no, sweeitie! This is America. A doctor’s job isn’t to do “whatever is possible to keep them healthy.”

In America, a doctor’s job is to minimize losses and maximize profits for the insurance companies. That’s how HMO’s work: Doctors only get paid when they DON’T treat patients.
HMO’s “manage” health the same way DRM “manages” rights the same way prison “manages” freedom

mediaempyre says:

To #45.
I feel your pain as to schooling and debt load when you hang the shingle out. I’m sorry, but some docs do have the holier than thou complex going on though. In the hall they can’t speak (yes I did say hello to you), act as though they know more about electronics than I do (20 yr wireless veteran), and tend to bark orders (I ain’t your operating room b*tch). These people tend to be WASPs in their mid 50’s.

Here in Southwestern PA that’s just the way they are. Unfortunately, they seem to represent you!

wkr md says:

Re: response

Thank you for understanding at least some of what I am trying to get across. That there are jerks in my profession is without question. Find any profession made up of completely type A+ personalities and you will find some major idiots. Understand that part of this egoistic behavior comes from having to deal with making difficult and complex decisions with incomplete data, knowing that your results are subject to criticism of the harshest kind, and having to have the ego strength to make those choices without having to second guess yourself constantly.

That being said, I don’t want to be overly apologetic. The surgeons tend to be the worst, but the behavior you describe is very real, and very unacceptible.

Bottom line, we need standards in healthcare IT that allow for better sharing of information, better access to data, and real world solutions designed by people who use them. Maybe someday we will have those tools and the medical world will be a better place. Universal health care will be a driving force to make that happen, I hope. Combine that with more mid-level practitioners (FNPs and PAs) and I suspect that just maybe physicians will begin to see themselves as a part of a team finally, not the captains of some imaginary ship as some do now.

Thanks you responding thoughtfully.

lilly adams says:

Right now, many health systems are taking advantage of recent changes to federal regulations and are connecting physicians and hospitals nationwide through Medical Prescription Software The federal Stark law, which limits the scope of hospital-physician relationships, has been relaxed to enable hospitals and health systems to assist physicians in adopting healthcare information technologies, including e-prescribing, to enhance patient safety and quality-of-care. Check out http://www.drfirst.com

Nobody Important says:

Stupid doctors and greedy health insurance providers

Most doctors have the GOD complex. We are at their mercy. They take kickbacks from the pharmaceutical companies for prescribing their medicines. I must say that not ALL doctors are like this. There are a few that are nice and have a good bedside manner and actually care about people. Many only care about their one patient that never gets sick in theirs eyes….Benjamin Franklin. In the last two years and 8 months my wife has been to 5 hospitals including the Cleveland Clinic and has seen 8 doctor of varying expertise. No one, but no one has helped her. She has a parasitic infection that was discovered in June 2008. One “Einstein” wanted to do skin grafts (we didn’t let him) and had her come back 11 times just to say “oh, it seems to be getting better”. It wasn’t. He was just soaking our health insurance company. Another nearly severed her ear with a non sterile scalpel. One proclaimed that “no parasites exist in this county! Another doctor that was supposed to be a specialist with parasites was from another country was an absolute moron with the worst bed side manner I have ever witnessed. “No worm, I see no worms!” He didn’t do a damn thing except he prescribed an antibiotic for her that did nothing. 20 pills – $1500. We hold a record at a local drug store. I wouldn’t have minded if it had worked. We even told our story to the show “Monsters Inside Me” but they never called. The renowned Cleveland Clinic was the worst. We drove 100 miles on a very snow night (that sounds overly dramatic but it’s the truth) and the first doctor would barely come near my wife when she saw the extent of the infection. She left the room and we waited an hour only to be told by another doctor wannabe that the infectious disease department was closed on the weekends! WHAT! If we were noteworthy people in Cleveland, people with influence and money, daughter of the Mayor, rich banker, lawyer, President of the United States…don’t you think they would have called in people immediately? Sure they would. That’s because MONEY TALKS! We are nobodies. I am sick of doctors playing god, I am sick of the fact that they can’t write English properly. What do they do in medical school, take special courses in scribbling? Kindergartners can write better. Insurance companies and doctors are why the USA’s health care system is a mess. And why is that? It also goes back to Benjamin Franklin. It’s all about the Benjamins. If Benjamin knew his likeness was on the $100 bill he would be dreadfully embarrassed. My rant, which is the same as spitting in the ocean, is over. There’s a lot more but I’m done. This message would be too long if I were to tell the whole story of what my wife has been through. No wait…one more thing, why don’t doctors put aside their massive egos and say, ” You know, I don’t know what that is but I assure you that I am going to contact some of my colleagues and find out what it is and how to treat it!” That never happened. OK, I’m done.

Susana says:

The Doctor’s hand written are so horrible. Most of the times us the pharmacy technician can’t read it. We ask the pharmacist and sometimes they can’t read it too. Eight out of ten doctors hand writing are difficult to read. We cannot make it out. They should make computerized prescription a must. The FDA should pass the law forbid the doctors to write their prescriptions so that patience won’t die because of the errors.

SomaGenix (user link) says:


SomaGenix Pharma Ltd.
Somagenix,a leading supplier of API’s and steroid hormone powders in Hong Kong. Our state of the art facility employs top chemical engineers and technicians while meeting quality assurance and compliance with North American and European standards. Our company allocates a substantial percentage of its investment towards Research and Development as we believe it is crucial in meeting market demands and innovation.

Katrina Wood says:

Maybe some doctors suffer paranoia?

I don’t know, but I do know I have just been prescribed five or so sets of antibiotics for a bizarre gum infection.

If there is any chance doctors are dishonest, this would be one reason for them to avoid writing prescriptions (and I am not saying that they are), as a doctor could be paranoid about it being scanned.

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