Take When Wet: Labels May Add to Medicine Errors

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Two common drug labels.

A study in the Journal for General Internal Medicine found that patients with a low level of literacy had trouble understanding drug warning labels. Some common misinterpretations for the top labels, according to the study's patient survey: "Don't take food." For the bottom label: "chew pill and crush before swallowing" or "just for stomach." Journal for General Internal Medicine hide caption

itoggle caption Journal for General Internal Medicine

Five Questions for Your Doctor


Take the initiative and ask questions. It's your right and responsibility as a patient. Here, five questions to ask your physician or pharmacist to make sure you have a proper understanding of how to use your medicine:


1. How many pills do I take at a time?


2. At what times of the day should I take these pills?


3. Is it important for me to finish all of this medicine?


4. Are there any specific instructions I need to know about how to take these pills? (i.e. with food or water, swallow whole, etc.).


5. What should I do if I miss a dose?

— Allison Aubrey

Two common drug labels.

From the same study, patient misinterpretations for the top label: "Don't drink and drive"; "don't drink alcohol, it's poison and it'll kill you." For the bottom label: "Medicine will make you feel dizzy" or "take only if you need it." Journal for General Internal Medicine hide caption

itoggle caption Journal for General Internal Medicine
Two common drug labels

Misinterpretations for the top label: "Don't take when wet"; "don't drink hot water"; "don't need water." For the bottom label: "Don't leave medicine in the sun." Journal for General Internal Medicine hide caption

itoggle caption Journal for General Internal Medicine

In an ideal world, doctors would write prescriptions in neat handwriting that everyone could read. And pharmacists would give precise directions about taking medicines.

But 61-year-old Buddy Landry of Shreveport, La., has learned that it's important to ask for clarification when prescriptions are unclear.

"I had developed lumps under my arm that were red and becoming painful, which scared me to death," Landry says. His doctors diagnosed his infection as folliculitis and wrote him a prescription for an antibiotic. Landry took the pills until the bottle was empty, but a few weeks later, his infection reappeared. When Landry contacted his doctor again, she asked whether he'd taken the second bottle of the prescription medicine.

"What second bottle?" he asked. Neither his physician nor the pharmacist had mentioned a second bottle. When Landry examined his bottle, he noticed the tiny print at the bottom of the bottle that said two refills were available in the next year. But he didn't know he was expected to fill them and take them.

Mistakes are Common

"Medication error is the most common medical mistake," says Terry Davis, chairperson of the Health Literacy Advisory Board at the American College of Physicians Foundation. Each year, there are about 530,000 adverse drug events related to medication error. Some lead to hospitalization and even death.

Many consumers and medical providers are too cavalier about prescription medications, Davis says.

"People don't slow down enough to be clear about how to take it," she says.

Vague Instructions

Several studies suggest that more explicit instructions on medicine labels would be helpful, says Michael Wolf, director of the Health Literacy and Learning Program at Northwestern University.

For instance, directions that include specific times, such as "Take at 8 a.m. and at 5 p.m.," might be better than instructions that say, "Take twice daily," according to Wolf.

Wolf's recent studies show that people often misinterpret the neon warning stickers that are placed on pill bottles by pharmacists. Some of the more common ones, such as "Take With Food," or "Medication Should Be Taken with Plenty of Water," are paired with images or icons that are confusing. The "For External Use Only" warning comes with a picture of a person with lines radiating around the body. People misinterpret this image to mean the medication is radioactive.

"The icons don't make any sense," says Wolf.

And the phrasing is awkward, too.

"If you go back to the late 1800s, you see the language from British apothecaries using the 'external use only' phrase. We just haven't changed anything," he says.

Wolf and his colleagues are pushing for change. They want the Food and Drug Administration to mandate some system of uniform labeling, similar to what appears on over-the-counter medications.

Pharmacies Introduce Change

Several chain pharmacies are making efforts to clear up some of the confusion. Last year, Target introduced new flat-surfaced pill bottles and new labels. One hallmark feature is that the store's name now appears in small print at the bottom of the bottle, so that the medicine's name and directions can appear in larger print at the top of the bottle.

Other changes include a color-coding system that assigns a color to each member of a family, so medications aren't confused. Target also dispenses syringes with liquid medications. The top of the bottle is custom fit to the syringe to help minimize dosing errors.

Self-Imposed Quality Control

Ultimately, it's up to the patient to ask doctors and pharmacists questions when medicine directions are vague.

"You are the one administering your medicine, not your doctor," Michael Wolf says. "You're in charge of quality control."

He suggests that whenever a person is prescribed a medicine, they take the time to learn how precisely to take it and whether a refill is needed.



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