Physician heal thyself
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Have you ever encountered a situation where a doctor’s prescription is illegible and cannot, in some cases, even be read by the pharmacist (who generally is able to read such handwriting)? According to current practice, prescriptions by doctors appear as a ‘scrawl’ or ‘scribble’, not legible, with the patient often left wondering whether he or she is getting the right medicine. The wrong medicine, because the prescription was not clearly read by the pharmacist, can be disastrous and even fatal to a patient.Writing legible prescriptions should be part of the code of conduct for medical professionals governed by the Sri Lanka Medical Council (SLMC), the legal authority for medical professionals. Incidentally, researching and reading the SLMC code of conduct came up with some interesting findings and a reality that doctors are not following the code in many instances.
For example, there is a punctuality clause which says that “having a ‘large’ practice, a ‘busy’ practice or being held up in another institution or theatre are not good enough to be accepted as excuses for being late”. Then there is this clause: “If questioned by a patient, it is in the best interests of the doctor to mention why he prescribes a particular brand of medicine or appliance” – but how many patients have the ‘courage’ to question a doctor? If interested, the link on ethical conduct of medical professionals can be accessed here – https://slmc.gov.lk/images/PDF_Main_Site/EthicalConduct2021-12.pdf.
So why, my dear readers, are we talking about doctors today and the code of conduct that is supposed to govern them? Well, there was an interesting court case in India recently about legible prescriptions. More on this later because I had to call a friend first to ask him about ‘legible medical prescriptions’. I reached out to Dosai Danny – my verti-clad friend from Trincomalee – who is a regular goer to see doctors because he has all kinds of ailments.
“Hi Dosai, have you had any problems with reading prescriptions,” I asked him on Thursday morning. “I can’t read it, but the pharmacist is normally able to,” he said. “But how do you know whether the pharmacist is reading it correctly,” I persisted. “Well, I have to take chances and hope for the best. In many ways, the pharmacist is also like a doctor; we are placing both our faith and fate in his hands,” he said.
In Sri Lanka, there are some doctors who provide printed prescriptions which not only give a clear prescription but also have details of the ailment. But these instances are few, with most doctors ‘scribbling’ a prescription in bad handwriting.
Well, back to the Indian court case. An October 1 BBC story from India on this issue was headlined, ‘No more scribbling: Indian court tells doctors to fix their handwriting’. It said that at a time when most people use keyboards to write, does handwriting really matter? Yes, say Indian courts, if the writer is a doctor!
The report said that the court order came in a case that had nothing to do with the written word. It involved allegations of rape, cheating and forgery by a woman and Justice Jasgurpreet Singh Puri was hearing the man’s petition for bail. The accused had denied the charges but when Justice Puri looked at the medico-legal report – written by a government doctor who had examined the woman – he found it incomprehensible.
“It shook the conscience of this court as not even a word or a letter was legible,” he wrote in the order, adding: “At a time when technology and computers are easily accessible, it is shocking that government doctors are still writing prescriptions by hand which cannot be read by anybody except perhaps some chemists.”
The Indian court asked the government to include handwriting lessons in the medical school curriculum and set a two-year timeline for rolling out digitised prescriptions. Until that happens, all doctors must write prescriptions clearly in capital letters, Justice Puri has said, according to the BBC report.
It said this is not the first time an Indian court has called out sloppy handwriting of doctors. Past instances include the high court in Odisha state which flagged “the zigzag style of writing by doctors” and judges in Allahabad high court who lamented about “reports written in such shabby handwriting that they are not decipherable”.
The report said Dr. Dilip Bhanushali, President of the Indian Medical Association that has more than 330,000 doctors as members, told the BBC that they’re willing to help find a solution to the problem. In cities and bigger towns, he says, doctors have moved to digital prescriptions, but it’s very difficult in rural areas and small towns to get prescriptions that are clear.
“It’s a well-known fact that many doctors have poor handwriting, but that’s because most medical practitioners are very busy, especially in overcrowded government hospitals,” he says. “We have recommended to our members to follow the government guidelines and write prescriptions in bold letters that should be readable by both patients and chemists. A doctor who sees seven patients a day can do it, but if you see 70 patients a day, you can’t do it,” he adds.
In Sri Lanka, most patients sit patiently listening to a doctor offering medical advice on their ailment: only a few would question the doctor. While some make the effort when seeing a doctor in a Colombo clinic or in an urban setting, the situation is different in rural areas where doctors are rarely questioned by patients.
This was also the case for the trio when I ‘happened’ to ‘overhear’ their conversation under the margosa tree on Thursday.
“Mama giya sumaney gedera gihama gamata, mata amaru badey kakkumak haduna. Ivasaganna bari wuna nisa, mata dosthara mahaththayawa balanna wuna (When I went home (to the village) last week, I had a severe stomach ache. I was forced to see a doctor because the pain was unbearable),” said Kussi Amma Sera. “Ithin beheth gaththada (So did you take any medicine)?” asked Serapina. “Dosthara mahaththaya beheth liyala dunna, eth mata eya liyala thiyena eka kiyawanna bari wuna (The doctor prescribed some medicine but I couldn’t read his handwriting),” was the reply. “Meka podu prashnayak nae, mokada beheth wattoru kiyawanna puluwan parmacy ayata witharai nae (This is a common problem as prescriptions can be read only by the chemist),” noted Mabel Rasthiyadu.
Before someone follows the Indian example and files a fundamental rights case in a local court saying the rights of patients are violated owing to unreadable prescriptions, the SLMC should run crash courses, even online, to ensure doctors are aware of the rights of patients. These rights include a clear prescription and also being punctual for consultations, among other issues.
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