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April 8, 1974

As Directed

Author Affiliations

University of British Columbia Vancouver

JAMA. 1974;228(2):159-160. doi:10.1001/jama.1974.03230270019015

To the Editor.—  Dr. Lerman (227:204, 1974) suggests that when he writes a prescription with the directions "Sig: With manufacturer's directions," the pharmacist should label all dispensed drugs with proper individualized instructions. He also recommends that the pharmacist should give the patient the package insert and underline the dosage instructions!As Dr. Lerman is aware, manufacturer's instructions contained in package inserts frequently list several different regimens that are dependent on many specific patient factors. If the pharmacist has access to the patient's record, he can assist the physician in determining the most suitable dosage for a specific patient. However, without this information it is dangerous as well as illegal for the pharmacist to determine the dosage.I agree with Dr. Lerman that verbal instructions are usually unreliable, and it has been demonstrated in the pharmaceutical literature that written instructions in common patient language are much more effective in improving patient