In an era where most people rely on keyboards for writing, one might question the significance of handwriting. However, Indian courts assert that it still holds importance, particularly when it comes to medical prescriptions. Jokes about the notoriously poor handwriting of many doctors—often only decipherable by pharmacists—are common in India and around the globe. Recently, the Punjab and Haryana High Court emphasized that “legible medical prescription is a fundamental right,” highlighting its crucial role in potentially saving lives.
This ruling emerged from a case unrelated to handwriting. It involved allegations of rape, cheating, and forgery made by a woman against a man who was seeking bail. The woman claimed that the man had taken money from her with the promise of a government job, conducted fake interviews, and sexually exploited her. The accused refuted the charges, asserting that they had a consensual relationship and that the case was brought forward due to a financial dispute.
During the proceedings, Justice Jasgurpreet Singh Puri reviewed a medico-legal report written by a government doctor who had examined the woman. He found the report incomprehensible, illustrating the importance of clear handwriting in medical documentation.
“It shook the conscience of this court as not even a word or a letter was legible,” he wrote in the order. The BBC has seen a copy of the judgement, which includes the report and a two-page prescription which shows the doctor’s unreadable scrawl. “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,” Justice Puri wrote.
The court has instructed the government to incorporate handwriting lessons into the medical school curriculum and has established a two-year timeline for implementing digitized prescriptions. Until this occurs, Justice Puri has mandated that all doctors write prescriptions clearly in capital letters.
Dr. Dilip Bhanushali, president of the Indian Medical Association, which represents over 330,000 doctors, spoke to the BBC, stating that they are committed to helping find a solution to this issue. He noted that while many doctors in cities and larger towns have transitioned to digital prescriptions, it remains challenging to ensure clarity in prescriptions in rural areas and small towns.
“It’s a well-known fact that many doctors have poor handwriting, primarily because most medical practitioners are extremely busy, especially in overcrowded government hospitals,” he explained. “We have recommended that our members adhere to government guidelines and write prescriptions in bold letters that are readable to both patients and chemists. A doctor who sees seven patients a day can manage this, but for someone who sees 70 patients in a single day, it becomes much more difficult,” he added.
This is not the first time an Indian court has called out the 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 the Allahabad high court who lamented about “reports written in such shabby handwriting that they are not decipherable”.
Studies, however, have failed to support the conventional wisdom that doctors’ handwriting is worse than others.
But experts say emphasis on their handwriting is not about aesthetics or convenience but a medical prescription that leaves room for ambiguity or misinterpretation can have serious – even tragic – consequences.
According to a 1999 report by the Institute of Medicine (IoM), medical errors caused at least an estimated 44,000 preventable deaths annually in the US, of which 7,000 were attributable to sloppy handwriting.
More recently, in Scotland, a woman suffered chemical injuries after she was mistakenly given erectile dysfunction cream for a dry eye condition.
Health authorities in the UK have admitted that “drug errors caused appalling levels of harm and deaths” and added that “roll out of electronic prescribing systems across more hospitals could reduce errors by 50%”.
India does not have robust data on harm caused by poor handwriting, but in the world’s most populous country misreading of prescriptions in the past has resulted in health emergencies and many deaths.
There’s this reported case of a woman who suffered from convulsions after taking a medicine for diabetes which had a similar-sounding name to an analgesic she had been prescribed. Chilukuri Paramathama, who runs a pharmacy in Nalgonda city in the southern Indian state of Telangana, told the BBC that in 2014, he filed a public interest petition in the high court in Hyderabad after reading news reports about a three-year-old who had died in Noida city after she was administered a wrong injection for fever.
His campaign, seeking a complete ban on handwritten prescriptions, bore fruit when in 2016, the Medical Council of India ordered that “every physician should prescribe drugs with generic names legibly and preferably in capital letters”.
In 2020, India’s junior health minister Ashwini Kumar Choubey told the parliament that medical authorities in states “have been empowered to take disciplinary action against a doctor for violating the order”.
But nearly a decade later, Mr Chilukuri and other pharmacists say that badly-written prescriptions continue to arrive at their shops. Mr Chilukuri sent the BBC a number of prescriptions he’s seen over the past few years that even he could not decipher.
Ravindra Khandelwal, the CEO of Dhanwantary – one of Kolkata city’s best-known pharmacies with 28 branches covering cities, towns and villages in West Bengal and serving more than 4,000 customers daily – says sometimes prescriptions that come to them border on the illegible.
“Over the years, we’ve seen a shift from handwritten to printed prescriptions in cities, but in suburban and rural areas, most are still handwritten.”
His staff, he says, are very experienced and able to decipher most of them to ensure customers get the right medicine.
“Even so, sometimes we have to call the doctors because it’s very important for us to dispense the correct medicine.”
Source: BBC
