Offbeat (12): Doctors prescribed legible scribbling!

By John B. Monteiro
Bellevision Media Network

You tell the doctor that y’are ill
And what does he but write a bill,
Of which you need not read one letter,
The worst the scrawl, the dose the better
For if you know but what you take
Though you recover, he must break.    

                                                                                   
-Mathew Prior, English poet and diplomatist (1664-1721).

 
 03 September 2012: A doctor’s fiancée goes to a chemist to get the doctor’s love note deciphered. This is a standing joke on the illegible handwriting of doctors. But can you understand your doctor’s scrawl? The answer would be no from most. It could soon be a thing of the past if one goes by the medical authorities’ prescription for doctors.According to a report by Hetal Vyas in The Times of India (29-8-12), taking a path-breaking initiative, the Karnataka Medical Council (KMC) has issued a directive to all 96,920 doctors registered with it to improve their handwriting while prescribing medicines. For, the clarity of a doctor’s handwriting is a very important part of healthcare communication.

 

In a directive issued on August 24, 2012, the KMC has requested all its members to write their prescription ’Legibly and Readable by a pharmacist’ and preferably in capital letters. "The trade name and within brackets the generic name of the drug prescribed along with signature and KMC registration number of the prescribing doctor is a must. The pharmacists are requested to co-operate in enforcing the order," Dr Chikkananjappa, president, Karnataka Medical Council, told TOI
A note has been sent to all the members of KMC after its meeting held on August 23. KMC has also informed the drug controller, the president of Karnataka State Pharmacy Council, principal secretary, health and family welfare department, and principal secretary, department of medical education. "For the purpose of ensuring that only correct medicines are given to patients, it is necessary that appropriate circulars are issued by the council impressing on doctors to write prescriptions legibly," reads the note.

Interestingly, doctors in Bangalore have lauded the KMC’s initiative. It is of utmost importance for the doctors to write a prescription legibly. It should be preferably written in capital letters. The reason is not only the pharmacist, but even a patient must understand the prescription," said Dr B Ramana Rao, senior physician cardiologist, who has been practising in Bangalore for 39 years.

Said Dr Yashoda Devi, a paediatrician:"If prescriptions are not written legibly, then there are chances of a pharmacist misreading it and eventually handing over wrong medicines to the patient. Also if the doctor does not mention about the dosage of medicine in clear handwriting, it can create trouble for the patient. It is therefore important for a doctor to write a prescription in capital letters”.

Before I return with a personal experience of top to bottom muddled mix up thanks to an illegible prescription, I wonder why the KMC did not go the whole hog by advising doctors to invest in a computer and printer and have it on a side table next to his consulting chair. Apart from generating clean prescriptions, he could also store the medical history of the patient in the hard disc so that he need not waste time in asking for it every time patient went to him. That would be spin-off which the KMC missed.

In Tulu language there is a saying “Anne barethina, annene vodod” – meaning what elder brother has written, only he can read. This could be because he is the only literate person in the family or his scrawl is beyond deciphering by others. The scrawls of doctors, not all of them though, are famous or infamous, depending how they work out at the dispensing chemist’s end. Some chemists are mind-readers and end up dispensing as the doctor intended. In other cases, chemists read what they want to read and end up dispensing what the doctor didn’t intend through his lazy scrawl. This can lead to disaster or end up in comic episodes. The latter happened to me recently.

 
Perhaps due to years of dying the thinning hair, some corrosive signs were noticed on the scalp and, on a visit to Mumbai, a noted dermatologist was consulted. And what did he do but write a bill and a prescription to justify the bill. My local doctor in Mangalore cannot boast of an easily decipherable handwriting. But he has a helpful practice of asking the patients to come back with the medicines dispensed by the chemist – to check if they conform to the prescription. He doesn’t distrust the readability of his scrawl but distrusts the deciphering prowess of the chemists.

 
 I had consulted the Mumbai specialist on the last day of my stay there. So, the six tubes of cream to last six weeks of treatment were dispensed by a leading chemist in Mangalore. So, the question of rechecking with consultant was ruled out. Even if I were in Mumbai, I doubt if I would have gone back to the consultant with the cream packet.  I had already paid ten times the local doctor’s visit fee for one consultation. How am I to be sure that the consultant wouldn’t charge me for the verification visit?

 
Six weeks of treatment over, the before-and-after photo prints showed no visibly discernible change on the pate. May be one more tube of cream might produce the desired results. So, I went around the local smaller chemists for a tube. None of them had the prescribed tube of cream. Instead they offered “Pilon” and not “Picon”, clearly written by the consultant.  On further prodding, they said that Pilon was for piles. Sensing something wrong, I went back to the leading chemist of my earlier purchase point and drew a blank on Picon. They have not heard of Picon and apparently misread the prescription, and given me what they had in stock Pilon. The bottom-line is that I used for the head what was meant for the bottom! I felt cheated as the whole exercise turned out to be pointless and futile as the pregnant woman rubbing vanishing cream on her bloating tummy with the hope of flattening it.

 My consultant in Mumbai heard my misadventure of mis-red prescription and allowed a faint smile to cross his face. Instead of laughing out my idiotic episode, he put a positive spin on it, saying if Pilon had worked on my scalp, as well as was expected of Ficon, We would have had a new discovery in medicine bypassing expensive and time-consuming clinical trials – by accidental serendipity. Doctors can be smug because they carry a comprehensive insurance  favouring them, no matter what they do – as noted by Francis Quarles, English poet (1592-1644): “Physicians, of all men, are most happy: whatever the success they have, the world proclaimeth and what faults they commit, the earth covereth.” 

 

 

Chew on this!

 

John B. Monteiro, journalist and author, is Editor of his website, www.welcometoreason.com (Interactive Cerebral Challenger) – with provision for instant response. Try responding!