Illegible doctors’ prescriptions can compromise the safety and quality of healthcare. This issue is less highlighted but has far reaching consequences. It is a global problem.
Although solutions are available, the problem is complex and merits discussion. Preventable medical errors harm around 30,000 people in the UK and 1.5 million in the US annually and illegible prescriptions are a contributing factor.
Incorrect medications, dosage and wrong route of administration are harmful and can have medico-legal implications. Abbreviations in Latin like qid or qd can be confusing.
Shortness of breath or SOB need to be explained fully. Lack of understanding can cause delay in treatment. At times, even professional colleagues fail to interpret the details of a prescription. Training of medical students in the formative years is essential.
Government medical colleges are welfare institutions. It is almost a regimented system where seniority is respected. It is difficult for juniors or students to tell the professor about poor handwriting in notes and prescriptions. Rather, it may be idolised by students and may seem like a requirement in medical school. A new graduate may feel that writing fast and illegibly may be a sign of a busy practitioner. There is a joke that students having poor handwriting in school can pursue a career as a doctor in future.
Deteriorating handwriting of medical students may have other reasons as well.
- Seeing many patients in a limited time.
- Need to do a lot of writing other than prescriptions, like preparing admission and discharge notes.
- Rapidly taking notes during lectures.
- Always in a rush in a long and stressful day.
- Unsure about spellings of difficult medical terms.
Poor handwriting in prescriptions is not related to the expertise or competence of doctors.
Surprisingly, it is confined to alphabets and not numbers.
Studies indicate that the handwriting of male doctors is much worse than their female colleagues. However, with some effort this problem is preventable.
A prescription generally has four parts.
- Superscription — the name and age of the patient is mentioned along with the date.
- Inscription — the medication is written.
- Subscription — dispensing directions to the pharmacist.
- Signature — the prescription is signed along with directions to the patient if needed.
Clay medical tablets found in Mesopotamia (present-day Iraq) and dating back to 2400 BC were among the oldest documented prescriptions.
The earliest known record of compounded medicine is found in Sushrata Samhita, a classical Sanskrit textbook on surgery which dates back to 6th century BC. The prescriptions were interpreted much later but no comment on handwriting was documented.
Public opinions regarding illegible handwriting of doctors are different.
- Doctors are not aware of the generic or trade names of many drugs.
- Prescriptions are written in code language for pharmacists only.
- Doctors like to keep the contents secret.
- Handwriting deteriorates as doctors attain seniority.
The actual situation, however, is different. No doctor desires to write illegibly. Writing in capital letters may be a solution.
Use of a fountain pen and ink instead of a ballpoint pen can be helpful as it can slow down the speed of writing.
Sometimes a bigger font size makes the writing more legible. Conducting workshops on handwriting in various countries have yielded remarkable results. Proper documentation by dictating to juniors can also be helpful. Studies have shown that doctors’ handwriting may not be worse than other professions though the value and consequences may differ.
Thirty-four per cent of prescriptions may not be legible according to a report. During the formative years, medical students are so engrossed with proper diagnosis and treatment that handwriting is not taken seriously.
Today hospital accreditation demands electronic medical records and e-prescriptions. This can settle problems related to illegible prescriptions. Although digitalisation can improve legibility, there are significant drawbacks.
- Figures and line drawings are not feasible for explanation.
- There may be typingerrors.
- During consultation the doctor is more engrossed in typing than communicating.
- Many doctors cannot afford assistants specially in personal clinics.
- All senior doctors are not computer friendly.
Patients and their families still have great respect fordoctors and carry out the instructions diligently. Some consider doctors as professionals only and demand e-prescriptions.
However, many do not desire their doctor to be like a data operator in a department store typing information without looking at the patient. They find it annoying.
The human touch and communication of the physician is considered much more important than the legibility of the prescription. Explanations can always be sought. Presently there is a great demand in the city for family physicians to visit patients at home. They give handwritten prescriptions and are not known to carry laptops and printers.
In the present era, proper documentation like e-prescriptions are essential, though the personal touch and human approach of a dedicated physician can never be replaced.
Your choice is important as it can make all the difference.
Author is a surgical oncologist trained at the Tata Memorial Hospital, Mumbai. He is presently associated with NH Rabindranath Tagore International Institute of Cardiac Sciences and NH Cancer Hospital