Danishwar Hameed
In the heart of Kulgam town, Abdul Rashid, a pharmacist, found himself in a perplexing situation when a customer handed him a doctor’s prescription. After futile attempts to decipher the names and dosages, he returned the note, prompting the customer to ask with concern, “You don’t have the medicine or is it too expensive?” The frustrated customer revealed, “This is the third pharmacy I have been to. My son needs the drug urgently.” In the midst of attending to another person, Abdul advised him to return the prescription to the doctor for a more legible one.
The longstanding humor surrounding doctors’ illegible handwriting is widely accepted within the medical community, yet, for certain individuals, it’s no laughing matter. The potential consequences of misinterpreting a prescription can result in improper treatment and even fatalities. Policymakers advocate for printed doctor prescriptions in various countries, emphasizing their safety by ensuring clarity and establishing a comprehensive database of the patient’s medication history.
The struggle to interpret doctors’ prescriptions is a shared experience that can pose serious risks, as discovered by PUNCH Healthwise. Whether intentional, a result of work pressure, or an innate quirk, the illegible scribbles contribute to medication errors, causing fatalities globally, as highlighted by Medscape India. The association highlighted that fatalities also occur when “pharmacists misunderstand or mis-record medication names or dosages conveyed messily on paper or hurriedly by phone.” The confusion created by sloppy handwriting leaves pharmacists and patients grappling with uncertainty, risking complications and even death due to overdosage. The association emphasized, “In the end, the patient is the one who suffers.”
It further noted that fatalities also arise when “pharmacists misunderstand or mis-record medication names or dosages conveyed messily on paper or hurriedly by phone.” “The sloppy handwriting makes everything so confusing that despite the prescription from the doctor, the pharmacist is unable to understand the name of the medicine and the patient is unable to understand whether he is given the right medicine or the wrong one.
“In the end, the patient is the one who suffers. If the medicine is consumed more than required, there is bound to be complications as overdosage also leads to the death of the patient,” the association stated.
Based on reports, doctors’ scribbled notes were meant to keep a personal record of a patient’s medical history and were generally seen only by the doctor. However, with dozens of other professionals having to work together over time, doctors became one element of a large, multidisciplinary healthcare team. The result of this expansion, our correspondent learned, is that illegible scribbles, hurriedly composed by rushed doctors, are now presented to colleagues with no qualifications in cryptology.
Originally intended as a personal record, doctors’ scribbled notes were traditionally for the doctor’s eyes only. However, as healthcare teams expanded, these illegible notes, hastily composed by rushed doctors, are now shared with colleagues lacking expertise in deciphering cryptic messages. According to a BMJ editorial by Leape and Berwick, handwritten medical notes were deemed a ‘dinosaur long overdue for extinction.’
Despite the availability of electronic prescription systems, doctors in Kashmir persist in using traditional paper and pen. In a 2005 U.K. study, three surgeons randomly selected operative notes from an orthopedic ward, revealing that only 25% of the notes were rated as good or excellent, while 37% were categorized as poor in terms of legibility by nurses, physiotherapists, and medical officers.
Prescriptions serve as a crucial document where doctors detail the name, dosage, route of administration, frequency, time, and duration of drugs for a specific patient (“index patient”). It also outlines non-pharmacological interventions like dietary recommendations, lifestyle modifications, and follow-up plans. At times, the prescription may encompass orders for tests, procedures, operations, and a concise version of medical opinions. Consequently, it stands as the most vital piece of paper for patients seeking relief or cures for their ailments.
Traditionally, a prescription was a physician’s directive to an apothecary, a professional skilled in drug preparation and dispensing. In earlier times, drugs weren’t readily available, requiring the apothecary to mix ingredients according to the physician’s instructions. The prescription typically commenced with the letter ‘R,’ crossed to denote an abbreviation (℞ or Rx), derived from the Latin term “Recipere,” meaning ‘take thou’ or ‘receive.’ This notation specified the materials to be compounded, a responsibility now carried out by pharmacists, succeeding the role of the old-time apothecary in executing all drug-related orders mentioned in the prescription.
“We went to the hospital at Kulgam as I was having a cough for some days, but there was a doctor named Sajad; he wrote my medicine for about Rs 100-1200. But when I went to the chemist to get the medicine, the chemist could not understand what was written on the prescription because of the doctor’s bad handwriting. After that, I went to other chemists around the area, but the result was the same,” said one patient Abdul Lateef who hails from Kulgam.
He said that even chemists told me that out of all places you have to go to this doctor. The other chemist sent the prescription to someone and that person told him what was written on the prescription after much difficulty.
“I also thought that I was having a mild cough, but he prescribed costly medicine which I don’t understand why. I can’t afford that much as I did not have that much money with me. After that, I went to a local medical shop and he gave me some tablets which I took as he also said that there is no need to take these too many medicines that the doctor has prescribed,” he told The Kashmiriyat.
Chemists around the hospital that we spoke to said that the handwriting is so pathetic that the patients have to be returned to the doctor’s chamber several times. “They complained to the concerned authorities about us not giving medicines, who in turn accused us of giving commission-based medicines and warned to cancel our licenses,” said Arif, a chemist (name changed).
Atif said that he has to return dozens of patients owing to the poor handwriting of doctors. “When we went to the doctor to ask him what medicine was written in it. He himself could not read it. Though it is a rare case, what’s not rare is the fact that the handwriting costs lives,” said Arif.
The Institute of Medicine (IOM) reported that 1.5 million injuries occur annually due to errors resulting from pharmacists and healthcare workers misreading illegible handwriting. These prescription-related errors lead to the death of approximately 7,000 Americans each year.
The courts have issued clear discretionary on this issue; in fact, a Lucknow bench of the high court found out that the medical lingo of three doctors related to three separate criminal cases paved a deterrent in the legal proceedings.
The judges weren’t able to read the medical prescription written by the doctors (and what’s the point of using the prescription in a legal case when only a doctor can read it?).
Therefore, in order to teach a lesson to the doctors, the bench of Justice Ajai Lamba and Justice Sanjay Harkauli imposed a Rs 5000 fine each to Dr. TP Jaiswal of Unnao, Dr. PK Goel of Sitapur, and Dr Ashish Saxena of Gonda.