Misinterpretation of Prescription Instructions by Lynn Stanton, M.D.


Medical Director

American Family Physician recently reports, “approximately 1.5 million adverse drug events occur each year, resulting in 117,000 hospitalizations annually” due to confusing prescription directions.  Although prescription wording and labeling standards exist, they are not universally adopted, regulated, or understood by the patient.  Adults over the age of 65, patients whose primary language is not English, and young children are at the highest risk for dosage misinterpretation.

Evidence shows that the best way for a patient to fully understand medication instructions is to learn them directly from the physician.  The “teach back” method is one effective for a physician or pharmacist to assess if the patient fully understands the directions.   The patient describes the instructions back to the provider using his own words.

Clear and concise wording on the medication label helps to prevent a lot of dosage issues.  According to the American Family Physician, medication instructions containing basic wording such as “blood pressure” vs. the medical term “hypertension” helps to eliminate potential confusion.  Additionally, wording such as “take two pills by mouth twice daily” can be confusing.  Instead, simple wording such as “take two pills with breakfast and two pills with dinner” leaves less room for guesswork.  Unfortunately, even the latter example can be confusing for those who do not have their meals 12 hours apart (such as many seniors).

If you are prescribed a medication or if you are a caregiver administering medicine, it is important to fully understand the dosage directions.  If you have any questions or concerns, contact a physician or pharmacist to properly learn the instructions.  It is a good practice to review your medications and dosage at every physician visit.   Do not be intimidated to ask if you are unclear about medication usage because an inquiry is the simplest solution to prevent potential health problems.

Source: American Family Physician.  “Health Literacy and Prescribing: It is Time to Change Old Habits”, June 2013

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.



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