Drug Labeling Blues: How Far Should Veterinarians Go to Ensure Their Patients Are Being Dosed Correctly?
Last year I experienced an unfortunate run-in with the kind of drug labeling direction pitfall that can happen to anyone: A client misread a label and overdosed her dog.
It was all quite innocent, really. I prescribed a common antibiotic drug for pets who suffer diarrhea complicated by bacterial overgrowths (and possibly by unseen parasites, too). But my client misread the labeling instructions and double-dosed her dog. Yeah … it happens.
Now this wouldn’t be a big deal in most cases. Problem was, Missy died. And the vet who examined her right after she died said she might’ve been overdosed with medication. Which, of course, brought the problem to lay right back in my lap — as you’d think it probably should, if (1) I’d actually recommended the dose Missy’s owner was administering, and (2) Missy’d actually succumbed to anything other than what an 18-year-old dog with end stage renal failure might reasonably be expected to. (Even veterinarians can overstate the cause of a dog’s death from time to time.)
Yes, Missy was on her last legs, God bless her. But there’s no doubting the reality: Missy’s owner was angry, thinking I’d overdosed her to death.
Luckily, I had the prescription label I’d written into my medical records and printed onto the drug label stored in the hospital computer’s medical records system. There was no doubting it: If Missy was overdosed to death (and I doubt it was anything less than her end-stage disease that did her in) it was her owner’s doing … not mine.
Still, that got me to thinking … how many owners simply misread their pets’ drug label instructions?
The subject was still percolating in my brain when I read yesterday’s Wall Street Journal article titled, "'Use Only as Directed' Isn't Easy."
Though the piece didn’t detail the exploits of wayward pet owners whose interpretation of common English isn’t always what it should be, it did delve into the secret life of cryptic labeling instructions that have a way of confusing anyone who might reasonably be expected to find their way around a drug label.
Here’s an excerpt for your infotainment:
Currently, consumers may receive as many as three different types of drug pamphlets with their prescriptions: package inserts written by the manufacturer and approved by the FDA, medication guides for certain classes of drugs and products required by the FDA, and consumer medical information provided by various third-party companies. However, recent studies by the FDA have shown that the information offered is not consistently understandable — and sometimes even conflicting or inaccurate.
Medication mishaps often happen in the hospital, due to clinician error and unexpected allergies or reactions. According to the Agency for Healthcare Research and Quality, the number of people treated in U.S. hospitals for illnesses and injuries from taking medications jumped 52% to 1.9 million between 2004 and 2008, the latest year available, including patients admitted from the emergency room. More than half of the increase was due to corticosteroids, blood thinners, and sedatives and hypnotics.
Another 838,000 patients were also treated and released from the ER with problems related to those and other medications, including painkillers, antibiotics, cardiovascular drugs, insulin and other hormones used to treat common diseases such as asthma, arthritis and ulcerative colitis. FDA officials say inadvertent errors made by patients who misunderstand information are causing significant harm. One reason cited is low literacy skills. A study in 2006 showed that of 70% of patients with low literacy who could correctly state the instructions "take two tablets by mouth twice daily," only 34% could then demonstrate the number to be taken daily.
Wow. That surely goes a long way towards explaining how a quarter pill twice a day could get translated into half a pill every twelve hours. Math is, after all, a skill many of us take for granted.
Should I, as a veterinarian, be reasonably expected to take more care when counseling my clients, seeing as when reading comprehension is an issue? Well … of course. And so I do, repeating directions in Spanish or Portuguese when necessary and even writing the prescription information in two languages if it seems prudent (and it often does here in South Florida). But how much explaining is reasonably considered adequate? And how far should a veterinarian go to ensure meds are being adequately allotted?
Dr. Patty Khuly