28 January 2011
By Jyoti Shelar & Vinay Dalvi
Straining to decipher bad handwriting, chemists lay down ground rules for how doctors should write prescriptions from now on
Tired of trying to make out the names of medicines scribbled hurriedly on prescription notes, pharmacists across the city have come together to demand more legible instructions from our medical practitioners. The Retail and Dispensing Chemists Association (RDCA), an umbrella body of 5,800 pharmacies in Mumbai, wrote to the Indian Medical Association (IMA) this week asking for "better" and "clearer" prescriptions from doctors. In the letter, the RDCA suggested that all prescriptions should either be printed, or written in capital letters only.
"Since we obviously cannot tell doctors to improve their handwriting, we’re demanding, at the very least, readable and neat prescriptions," said Prasad Danave, general secretary of the RDCA.
Perhaps a good way to avoid a situation like the one faced by a young girl, who had gone with his parents to the Chetna Childrens’ Hospital in Ambernath complaining of a stomach disorder. She was asked by Dr Chetna Shah to have an Aciloc, but ended up getting an Azilac, a medicine for throat infection. Naturally, she didn’t get better.
When contacted, Dr Shah said it was the chemist’s fault. "These errors are common. The problem is that not every one in the shop is qualified. Some are even illiterate, and get easily confused with names of new medicines, or with medicines with similar names,"
Shah said. "It’s typical," countered Danave. "The chemist is blamed every time a wrong drug is given to the patient, and not the doctor for writing sloppily. Unclear abbreviations and wrong dosage indications sometimes lead to serious consequences for patients, causing various side effects and sometimes bigger problems."
While there are no figures to demonstrate the problems that poorly written prescriptions lead to in India, a recent report by the Institute of Medicine (IOM) in the United States stated that more than 7,000 Americans died annually, and 1.5 million got worse, rather than better, due to wrong dosage as a result of sloppy handwriting.
Which brings us to the question: Why do doctors, across the world, write so illegibly?
"We don’t start out so badly," said Dr Anil Mathur, "we just get worse over time, dealing with hundreds of patients every day as resident doctors in hospitals. Since you get only a few minutes to examine patients and write their prescriptions, you start getting sloppy. Before you know it, your handwriting has changed forever."
Dr Hemant Thacker, a consultant physician at Jaslok Hospital, blamed it on being too focused on diagnosis. "The doctors are so engrossed in their medical instruments, and so preoccupied with trying to figure out what’s wrong the patient, that they don’t take writing on paper seriously," he said.
There is, however, a business angle as well. "In a country of self-medication, if patients start understanding what we’ve written, why would they come to us again?" said Dr RS Mittal, tongue firmly in cheek. "But, it’s true, some doctors write so badly, almost in code, so that only their nearby chemist can understand it. Good for both parties."
When contacted, the IMA said it had taken note of the chemists’ letter, but described their demands as "impossible to implement". "I agree that prescription errors are very common due to the bad handwriting of the doctors. We’ve been instructing doctors across the country to at least write in a readable format, but it’s not possible for every small physician and dispensary to provide typed prescriptions," said IMA’s joint secretary. Dr Narender Saini.
In Mumbai, the state-run JJ hospital has been giving printed prescriptions since May last year, after complaints of wrong dosage started mounting. "We decided to computerise the system as there were several issues with hand-written prescriptions," said the hospital’s dean, Dr TP Lahane. "Doctors sometimes get too casual. For them, writing is not a priority, no matter how many times you point it out. So, we’ve decided not to trouble them anymore."