By: David Ahn, MD

The iPad and the tablet market continue to make significant headway into the medical and business markets. In a previous article I wrote about the unique features of the iPad, I briefly mentioned that it was sorely missing the ability for fine-tip stylus recognition.

Currently, the iPad’s capacitive touch screen beautifully recognizes the touch of a human finger, but is poorly suited for the fine tip of a stylus. As a result, styluses designed for the iPad are all thick-tipped, and writing/drawing with them are akin to using a blunt Sharpie marker. However, the practice of medicine often requires the grace of a pen, and would benefit from improved stylus support in future generations of iPads and tablets.

Doctors and Handwriting: A Bad Combo?

An obvious stereotype for physicians — we are known for having poor penmanship.  In addition to the simple fact that we do indeed have horrible handwriting, it’s also because handwriting plays a key role in our practice: prescription pads, patient encounter documentation, medical-legal paperwork, and more. While replacing handwriting with text will improve the readability of many doctor’s notes, I still think there are significant tradeoffs with eliminating the option for fine-tip writing.

Handwriting Can Be More Easy to Read Than Type

Just to be clear, I dislike interpreting the hieroglyphics of a physician as much as anyone else, but in certain respects, a handwritten note can be more readable than a text note. For example, typed notes often have a density of excess information that includes blocks of text that lack focus and clarity. For example, in a typed HPI (history of present illness), it can be hard to sort through pertinent positives and negatives because the nature of typing lends to more information, complete sentences and prose rather than simple abbreviations and pertinent phrases.

Even beyond the shear difference in quantity of words/letters used, there is a clarity that handwriting provides with spacing and distribution of words on a page. Many handwritten patient notes use multiple columns and complex organization of text with random boxes of text (e.g. medication list being listed in a small box on the right), which require more effort to reproduce on a typed note. This is often why typed notes can span over 2-3 pieces of paper, where a handwritten note will rarely go over one sheet.

Drawing and “Marking Up” content provides utility

At our hospital, since we have paper charts, we have two choices when writing progress notes: printing out typed notes or handwriting notes on printed rounds reports. One benefit to handwriting on printed rounds reports is it allows for circling pertinent lab results and fully integrating personalized, subjective notes with the objective data on the report.

In addition, certain specialties benefit significantly from drawings or symbols. One example would be cardiologists who often like to diagram which heart vessels have blockages or have had stents placed. Another example would be when describing skin lesions or documenting reflexes, it can help to illustrate with traditional stick figures.

Handwriting is Personal and Unique to Each User

Think about a signature: it is a personal, handwritten identifier that holds significance in our society. When it comes to medication prescriptions and medical-legal forms (ex: medical disability paperwork), physicians are often required to handwrite their recommendations and signature. In a more general example, when sending a thank-you card, there is a humanness that is more appropriately conveyed with a pen rather than a keyboard. The unique nature of each person’s handwriting speaks as to the genuine authorship, and this can go a long way with the various responsibilities of a physician — such as more “personalized” discharge instructions for a patient.

Conclusion

Apple CEO Steve Jobs has previously said in an interview that a stylus is only required in a poorly-designed product, saying “if you see a stylus, they blew it.” I see where Mr. Jobs is coming from and agree with his sentiment that the majority of a well-designed user interface should not require a stylus. Furthermore, I much prefer typing to handwriting in most situations. I can type significantly faster than I can write. I struggle to read the poor handwriting of some of my peers.

However, at times, the pen is almost as integral to a physician’s practice as a stethoscope, and I eagerly hope for this feature in the next generation of iPads and other tablets. What about you? Do you think the iPad’s lack of fine-tip stylus support is a big deal? Share your thoughts about this in the comments.

Note: Over the next several weeks, I will be reviewing several of my favorite styluses and notepad apps for the iPad/iPhone. If you have any that you’d like to recommend, feel free to let me know in the comments as well.