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Drug Labeling Blues

Posted: August 17, 2011, 8:30 p.m., EDT

Patty Khuly, VMD, MBA

How far should we go to ensure our 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 (you know the one). 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 veterinarian who examined her right after she died (a down-the-street colleague––not the ER, it should be duly noted) claimed she had been overdosed with the medication. Which, of course, was interpreted by her owner to mean I had killed Missy.

Which might’ve been the case if 1) I’d actually recommended the dose Missy’s owner had been giving (in fact, I had not) and 2) Missy’d actually succumbed to anything more than what a 19-year-old dog with end-stage renal failure might reasonably be expected to die of. Namely, renal failure.

But there’s no doubting the reality: Missy’s owner was angry thinking I’d overdosed her to death. And it didn’t help that the down-the-street-colleague-who-shall-not-be-named actually penned a letter to this effect in anticipation of possible legal action, going so far as to offer appropriate dosage information for my future reference. (Nice of him to take it upon himself to damn a colleague without reading Missy’s medical records first.)

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, it was her owner’s doing ... not mine.

Still, that got me to thinking ... how many owners routinely misread their pets’ drug label instructions?

The subject was still percolating in my brain when I read a recent 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 what it should be, it did delve into the secret life of the kind of cryptic labeling language physicians and drug companies are wont to employ.

Because, as the article describes, it’s not enough for patients to receive 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. Not when even the FDA says the information contained therein is often neither understandable, consistent or accurate.

Then there’s the poor handwriting quality and questionable writing skills to contend with––not to mention the reality of actual errors made by the multilayered trilogy comprising clinician, receptionist and pharmacist.

Which is partly how 1.9 million people came to be sickened by mis-taking their meds in 2008 alone (the latest year available for this figure).

But make no mistake: Reading comprehension accounts for a significant proportion of this kind of drug abuse. Indeed, a 2006 study referenced by this Wall Street Journal article demonstrated that of 70 percent of low literacy patients who could correctly state instructions on the side of a medicine bottle, only 34 percent could then show that they knew how many pills they needed to take.

Which is a discrepancy that surely goes a long way toward explaining how a quarter pill twice a day could get translated into half a pill every 12 hours (Missy’s mom’s misread). Math and reading are, after all, skills too many of us take for granted.

So here’s the question (you knew it was coming):

How far should veterinarians go to ensure that our patients are receiving the right number of pills, milliliters, drops, etc.? Seeing as reading comprehension is such a pressing challenge to public health, shouldn’t we work harder to ensure our patients are getting treated to what we prescribe?

But how much explaining is considered adequate? And in light of the dire consequences as for some medications (think lysodren and insulin, for example) is “adequate” really enough? So how far should a veterinarian go to ensure meds are being adequately allotted?

I really have no answer save to ensure that beyond offering the basics the law requires—and a few more niceties thanks to computer technology—there’s as much clarity and redundancy surrounding the instruction process as my staff and I personally have time for.

Call me heartless but still ... I can’t help but think that taking personal responsibility for a pet isn’t just about showing up for annual vet visits and basic home care. It also includes paying close attention to drug directions. That, and not taking it out on the veterinarian when your reading comprehension gets in the way of her orders.  

Dr. Khuly is a mixed-animal practitioner in Miami and a passionate blogger at PetMD.com/blogs/FullyVetted. She earned her veterinary degree in 1995 and her MBA from Wharton in 1997.

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