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Prescribed: capital letters

New Delhi, Feb. 2: Doctors across India should write the names of medications they prescribe to their patients only in capital letters, the country’s apex medical regulators have said in a move intended to counter the legendary illegibility of prescriptions.

The Medical Council of India has approved a draft notification that directs doctors to write drug prescriptions in full capital letters. The notification will need to be approved by the Union health ministry before it slips into the rulebook for doctors nationwide.

“There have been long-standing concerns about (doctors’) handwriting — we want prescriptions to be legible,” Jayshreeben Mehta, president of the MCI and former professor of surgery at the Government Medical College, Vadodara, told The Telegraph.

Sections of India’s medical community have often warned that a combination of illegible handwriting on prescriptions and similar-sounding brand names of drugs for different illnesses could place patients at serious risk of receiving wrong medications.

“The similarities in some brand names are shocking,” said Padmanabh Rataboli, professor of pharmacology at the Goa Medical College, Bambolim, who has been compiling lists of potentially confusing brand names of drugs sold across the country. A patient who has been prescribed an antibiotic in poor handwriting, Rataboli told this newspaper, may well receive a drug designed to correct sexual dysfunction from a retail chemist.

A minor mistake in legibility on a prescription by a doctor or a careless reading of the prescription by a dispensing pharmacist may cause serious harm to patients, Rataboli had warned nearly a decade ago in a paper in the Journal of Postgraduate Medicine. Several audits of prescriptions over the past decade have documented poor handwriting.

An analysis of 1,046 prescriptions — 614 by doctors in a teaching hospital and 432 by private practitioners — from Ujjain district in Madhya Pradesh two years ago had revealed that 12 per cent of prescriptions by teaching doctors and 24 per cent of prescriptions by private practitioners were illegible.

“I would fully support the MCI decision on capital letters,” said Ashutosh Chourishi, associate professor of pharmacology at the Ruxamani Devi Gardi Medical College, who had conducted the prescription audit. “I would also think it’s important for prescriptions to spell out the generic names of drugs.”

An independent audit of 499 prescriptions written by doctors in a tertiary level hospital in Maharashtra three years ago had found that 88 prescriptions (17 per cent) had been written in illegible handwriting that was not easily readable. The results of the audit, published in the Australasian Medical Journal, also showed that the dose of the drug was written clearly only on 65 per cent of the prescriptions.

Bad handwriting among doctors is not an India-specific problem. A survey from Italy published in the journal BMC Clinical Pharmacology, four years ago had found that 23 per cent prescriptions were illegible and nearly 30 per cent were incomplete. A decade ago, an audit of critical care units in the UK found that about 15 per cent of prescriptions had one or more errors.

“The problem in India has been worsened by similar brand names,” Rataboli said. “It’s disgusting how our drug regulators allow this. There needs to be a a catalogue of brand names already approved so that similar sounding drugs can be avoided.”

Doctors have at times attributed poor handwriting to lack of time. “The number of patients is huge, particularly in public hospitals,” said Vinay Jindal, a neurosurgeon at the Goa Medical College, who is a member of the MCI executive committee. “We’re trying our best to improve things. Let’s see how this works out.”