Tessy Igomu, PunchNG
A doctor’s handwriting can mean the difference between life and death for a patient, as sloppily written prescriptions can be misread or dosage wrongly interpreted.
For minutes, Kingsley Onuoha, a pharmacist in Ajao Estate, Lagos, stared at a doctor’s prescription handed to him by an agitated female customer.
Frustrated after several failed attempts to guess the names and dosages of the drugs scribbled on the paper, the pharmacist returned the note to the customer.
“You don’t have the medicine or is it too expensive?” she asked, with a worried expression.
Continuing, the obviously exasperated customer added, “This is the third pharmacy I have been to. My son needs the drug urgently.”
The pharmacist, who was already attending to another person, simply told her to return the prescription to the doctor and have him write another one that could easily be read.
A killing machine
Getting to decipher some doctors’ prescription notes can sometimes prove herculean for patients, pharmacists and even fellow physicians.
To many people, it has become an accepted ‘fact’ that doctors don’t have perfect handwriting. The question, however, is whether it is an intentional act meant to discourage self-medication on the part of patients, or whether it is done due to work pressure or it is an innate gift peculiar to them.
Whatever the reasons behind doctors’ usually illegible scribbles, the danger it poses to everyone concerned is alarming, as PUNCH Healthwise discovered that it causes medication errors that kill hundreds of people globally.
According to non-profit organisation Medscape India, which spearheads a campaign to address the issue, the number of fatal incidents due to doctors’ unreadable prescriptions is internationally on the rise.
It noted that doctors’ illegible handwriting in medical records or medical prescriptions could put patients at risk as they may end up receiving wrong treatment.
“The staff struggling to read the doctors’ notes may write the wrong medication for the patient.
“Most of the chemists don’t have full-time pharmacists, resulting in the uneducated salesman handling prescriptions.
“With an illegible prescription and an uneducated salesman, the concoction could well be catastrophic.
“In all the final analysis, the patient becomes a victim of combined negligence,” the online portal stated.
A 2001 British paper reported that more than 10 per cent of handwritten prescriptions contained errors; while U.S. studies have found that 20 per cent of prescriptions or more were unreadable or readable only with effort.
Based on a 2006 report by the National Academies of Science’s Institute of Medicine, in the U.S. alone, doctors write about 3.2 billion prescriptions annually, but poor handwriting on such notes leads to over 7,000 deaths and 1.5 million medical errors.
The association noted that many of such errors result from unclear abbreviations and dosage indications that make patients unable to understand which medication needs to be consumed and in what amount.
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 over dosage 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 learnt, is that illegible scribbles, hurriedly composed by rushed doctors, are now presented to colleagues with no qualifications in cryptology.
According to an editorial in BMJ, a peer-reviewed research journal, authored by Leape and Berwick, handwritten medical notes were called a ‘dinosaur long overdue for extinction.’
The journal noted that in 2005, three surgeons audited the legibility of 40 randomly selected operative notes from an orthopaedic ward in a large British hospital.
BMJ stated that two nurses, two physiotherapists and two medical house officers were asked to rate the legibility of the notes as ‘excellent,’ ‘good,’ ‘fair,’ or ‘poor. ’Their findings showed that only 24 per cent were rated ‘excellent’ or ‘good,’ and 37 per cent were deemed ‘poor.’
Bane of the medical profession
Admitting the possibility of unreadable doctors’ prescription causing deaths, a General Practitioner, Dr. Edward Chukwurah, said such sad occurrences will continue to be the bane of the medical profession as it has become an all-comers affair.