Medical errors cause between 44,000 and 98,000 deaths annually in the United States alone, with approximately 7,000 of these deaths attributed to sloppy handwriting
The 1968 American crime comedy, “Take the Money and Run”, directed by Woody Allen, humorously yet poignantly illustrates the significance of legible handwriting. In one memorable scene, Virgil attempts to rob a bank. However, his plan is thwarted not by an alert security guard or a silent alarm, but by his own indecipherable illegible handwriting. His handwritten robbery note, intended to read “gun” and “act natural”, is misinterpreted by the bank cashier as “gub” and “abt”. This misunderstanding results in a humorous situation where Virgil is forced to explain his note, inadvertently revealing his intention to rob the bank, which leads to his arrest.
This film serves as a stark reminder of the importance of clear and legible handwriting, and the potential consequences of neglecting this essential skill especially for the medical practitioners who may be at risk for their zic-zac jargons.
Even today, after almost half a century, our doctors have not learned to write legible prescriptions. One such case that has attracted my attention is from the state of Assam, where a person was admitted to a hospital in Guwahati due to convulsions. Despite thorough examination and investigations, the medical team could not identify a specific cause. However, a staff nurse discovered that a doctor in Delhi had prescribed her ‘Duodil’, a medication for muscle spasms and associated pain and discomfort.
Due to the poor quality of the doctor’s handwriting, the pharmacist mistakenly dispensed ‘Daonil’, a medication for diabetes. The patient took this incorrect medication for several days, which led to a sudden drop in her blood sugar levels and triggered the convulsions. This serious incident was primarily due to the illegible handwriting of the doctor who treated her in Delhi.
This case highlights the critical importance of clear and legible handwriting in medical records. Misinterpretations due to poor handwriting can lead to incorrect treatment, potentially causing harm to patients and leading to legal implications for healthcare providers. It is a reminder for all healthcare professionals to ensure their handwriting is clear and legible to prevent such incidents.
In the 1750s, American apothecary John Morghan pioneered the use of prescriptions, which were primarily utilised as reference books by doctors and apothecaries. A typical prescription is composed of four sections that includes superscription, inscription, subscription, and signature. More than just a shopping list for the pharmacy, a prescription is a meticulously organised document containing details about the prescriber and patient. It functions as a guide for the patient or their caregivers, a medication record for pharmacists, and a log of the patient’s medical history for other healthcare professionals. Despite their critical role, the legibility of some doctors’ handwritten prescriptions can pose challenges for pharmacists and the patients.
Reports and studies conducted over the years have highlighted the severe consequences of illegible prescriptions. One such study estimated that medical errors cause between 44,000 and 98,000 deaths annually in the United States alone, with approximately 7,000 of these deaths attributed to sloppy handwriting. Similarly, in the United Kingdom, approximately 30,000 deaths occur each year due to medical errors, with illegible prescriptions contributing to a significant portion of these cases. In India, poor handwriting has also led to patient deaths and increased the occurrence of medical errors, although the lack of comprehensive data makes it challenging to determine the exact numbers.
Noticing the chaos caused by these illegible medical prescriptions, the courts have stepped in with their clever recommendations and directions. Recently the Orissa High Court has issued a directive to address the issue of doctors’ illegible handwriting. The court has instructed the state government to ensure that all medical documents, including prescriptions and post-mortem reports, are written in legible handwriting, preferably in capital letters or typed. This move aims to make the doctors’ handwriting understandable to both the public and the judiciary. The Orissa High Court has earlier also recommendedthe doctors to embrace the beauty of capital letters. The Lucknow bench of the Allahabad High Court has enforced a monetary penalty on three doctors who seem to have taken the art of handwriting to a whole new level of obscurity.
In 2018, the Uttarakhand High Court at Nainital directed all doctors whether in government, public or private clinics and hospitals to issue computer-generated prescriptions and not handwritten ones so that patients and their care givers understand them.
Globally, illegible handwriting of doctors is a concern. In 2017, a Bangladesh court banned the sloppy scrawl after prescriptions became so illegible that patients were taking the wrong medicines.
In the United States, the Joint Commission, which accredits healthcare organizations, has also addressed this issue. In 2006, they issued a “Do Not Use” list of abbreviations as part of the requirements for accreditation. This was in response to many medication errors caused by misinterpretation of handwritten orders that used these abbreviations.
In the United Kingdom, the National Health Service (NHS) has implemented electronic prescription services to reduce errors due to illegible handwriting. This system allows prescriptions to be sent electronically from the GP to the pharmacy, eliminating the need for a handwritten prescription.
Recognising the serious issue of illegible handwriting in the medical profession, Chilukuri Paramathma, a pharmacist from Andhra Pradesh, took a stand. In 2014, he filed a public interest litigation in High Court at Hyderabad, challenging the confusing style of prescription writing. He cited numerous incidents to highlight how pharmacists were dispensing incorrect medications to patients due to poor handwriting on prescriptions. One such incident led to a tragic miscarriage when a pregnant woman was given the wrong medication by a pharmacist at a pharmacy chain store in Vidyanagar, Hyderabad. At that time, the Medical Council of India (MCI) had no specific guidelines for prescription writing, although Maharashtra had developed a model prescription format. In response, the MCI issued directions in 2016, instructing doctors to write prescriptions in clear, legible handwriting and to use generic names for medications.
Although the initiative of MCI was a good move but this protocol is hardly being adhered to by certain practitioners as there is no monitoring mechanism to its adherence. This is a grave cause of concern. Research indicates that in rural areas, legible prescriptions are penned by merely 20% of doctors. Furthermore, it’s been observed that only half of the doctors in India actually affix their signatures on the prescriptions they write.
The issue of illegible handwriting also attracted the attention of Prime Minister Narendra Modi who in, 2017 announced that the government intends to ensure that doctors prescribe medicines by generic name and write prescriptions in such a way that the poor people do understand their handwriting. He ensured to bring in a legal framework by which if a doctor writes a prescription, he has to write generic names in a legible manner.
Despite these measures, the problem of illegible handwriting persists in the medical field. It’s clear that more needs to be done to ensure patient safety. Some suggest that medical schools should include handwriting classes in their curriculum. Others believe that the complete transition to electronic health records is the only solution.
To address the issue of illegible prescriptions, healthcare systems have been implementing various measures. Electronic prescribing systems (e-prescribing) have gained prominence, allowing healthcare providers to generate digital prescriptions that can be electronically transmitted to pharmacies. E-prescribing reduces the risk of errors caused by illegible handwriting and enhances the efficiency of prescription processing. However all these measures will take time to implement till than the entire rick lies on the head of the mere patients.
So, dear doctors, the next time you wield a pen, remember – your handwriting is not just a reflection of you, it could be a matter of life and health. Channel your inner Virgil Starkwell, but instead of “Take the Money and Run”, let’s “Take the Pen and Write… Clearly!”
And that, dear readers, is the long and short of it. Until next time, keep those letters legible and your spirits high!
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