Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Prescription labels need to come in languages other than English

David Margolius, MD
Meds
June 8, 2013
147 Shares
Share
Tweet
Share

shutterstock_139652441

As the saying goes, “With great power comes great responsibility.” That applies to physicians when prescribing medications, but it also should apply to pharmacies when they’re dispensing medications.

In December, after seven years of exams, lectures and rounds, I received my medical license. Finally, I had the power to prescribe medications without the co-signature of my supervisor. “Be careful,” she advised, “remember the story of ‘once.'”

The story of “once” is a cautionary tale that — best as I am able to tell from Google — was adapted from a Spanish soap opera.

In one version, a doctor prescribes a patient a 30-day supply of a medication. Three days later, the patient returns for a refill. “How can this be?” the doctor wonders. The Spanish-speaking patient responds, “I took the pills exactly as the bottle said to: ’11 daily.'” The doctor scrutinized the pill bottle: “Take once daily.” But “once” read and pronounced “ohn-say” means 11 in Spanish. The patient had taken 11 pills daily, just as the bottle label said — in Spanish.

The patient lives in that story, but in other versions he is hospitalized or even dies. Shortly after I received my license, I had my own version.

Mr. P is a 65-year-old gentleman originally from Mexico. He speaks English well enough to have a light conversation but would be classified as limited English proficient, or LEP. That means he speaks English less than “very well,” and he is not unique: 40% of Californians speak a language other than English at home, and more than 6 million Californians are LEP.

He has diabetes, high cholesterol, high blood pressure and coronary artery disease, and takes 10 medications daily. He is a perfect candidate to be one of 150,000 Californians who are sickened or killed each year because of medication errors.

I had hoped to help him. He was taking one blood pressure medication twice a day, so I changed it to the once-a-day formulation. I wrote “Tome 1 pastilla en la noche” on a sticker and stuck it to the bottle to avoid any “once” pitfalls. I felt that this was part of my responsibility as a prescriber of medications.

Three months later, Mr. P ended up in the hospital. He had begun to feel lightheaded a week before, and then he fell. His heart rate in the emergency room was dangerously low. After an extensive evaluation and ultimately a visit to his home by a nurse, we discovered that he had resumed taking his blood pressure medication twice a day, despite being given the new once-a-day formulation. He in effect had doubled the dosage I had prescribed.

The directions I wrote out may have worked, but then he received his first refill and a new pill bottle. Although many pharmacies in California (including some but not all large chains) print non-English directions on pill bottles, his did not.

The Legislature is considering a bill — SB 204 — that would help; it’s moved to the Assembly after passage by the state Senate. If it becomes law, pharmacies will be required to print standard medication instructions translated into languages other than English on pill bottles. The instructions are already available in Spanish, Chinese, Vietnamese, Korean and Russian on the Board of Pharmacy’s website. With this law, they would be printed on the bottles themselves. (New York has a similar law.)

I, with my power to prescribe, almost killed my patient. Pharmacies, with their power to dispense and advise, could have helped keep him out of the hospital. The Legislature should make this procedure the law.

David Margolius is an internal medicine physician. He testified before the California Senate Committee of Business and Professions in April in support of SB 204.

Image credit: Shutterstock.com

Prev

MKSAP: 52-year-old man with leg pain and swelling

June 8, 2013 Kevin 0
…
Next

How defensive medicine is akin to the war on terrorism

June 8, 2013 Kevin 7
…

Tagged as: Medications

Post navigation

< Previous Post
MKSAP: 52-year-old man with leg pain and swelling
Next Post >
How defensive medicine is akin to the war on terrorism

More by David Margolius, MD

  • Permission to take my patients’ plasma. It’s a harder decision than you think.

    David Margolius, MD
  • a desk with keyboard and ipad with the kevinmd logo

    For patients, reforming the RUC matters

    David Margolius, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How teamwork can help improve primary care access

    David Margolius, MD

More in Meds

  • Levamisole is good for your dog, but bad for your cocaine

    Robert Killeen, MD
  • 13.1 million missing Americans since 1980. Where’s the outrage?

    Steve Burgess, MD
  • Ketamine for mental health conditions: What every primary care physician needs to know

    Carlene MacMillan, MD & L. Alison McInnes, MD
  • Learn to be a Narcan hero: a comic tutorial

    Emily Watters, MD
  • The preference for insurance coverage of opioids over non-pharmaceutical options explained

    Amy Baxter, MD
  • A comic reveals the terrifying truth about fentanyl

    Emily Watters, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 73 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Lab Tests That Escape FDA Oversight May Come Under Agency Review
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Low Tidal Volume Compliance Still Lacking in Mechanical Ventilation
  • IV Immunoglobulin May Cut Infection Risk of Anti-BCMA Agents for Myeloma
  • When's the Best Time to Get the Updated COVID Shot?

Meeting Coverage

  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Prescription labels need to come in languages other than English
73 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...