A Dangerous Business

There was this disturbing news in yesterday’s daily which prompted me to write this.

A couple was undergoing treatment for infertility for the last few years, and finally conceived. Everyone was happy,  the patient,her husband, the doctor, and the whole family. The doctor then prescribed a medication for the safe continuation of the pregnancy. She was asked to take one tablet daily for a month. About a week after taking the medicines, the patient started feeling unwell. At the end of the course of medications, she attended the doctor for review, and he gave another  prescription to continue the same medication for a further two weeks. She couldn’t continue the medications because of severe side effects and was admitted to the hospital. It was then they found that the woman was taking a wrong medication all along. She was supposed to take a hormone to sustain the pregnancy, but received a medication to induce abortion!!And the strangest thing is that the wrong medicine, which should have induced an abortion in few days, was ineffective, even in its proposed function. The drug was also capable of inducing malformations and birth defects in the baby, and so the pregnancy had to be terminated.

This was really disturbing news to me. Further reading into the matter revealed that the prescription was grossly illegible and the pharmacist mistook it for another medicine.

At the hospital where I work, we have faced similar problems many times,and still do. Some doctors appear to be decided they will write only illegible notesand prescriptions. Even when relaxed and comfortable, some of them appear to become frantically busy when they write prescriptions. The result is an illegible tangle of lines. The pharmacists sit scratching their heads and ultimately call the doctor himself for help. Many times we had patients who were brought unconscious after taking Diamicron ( a tablet for diabetes) instead of Diovan ( medicine for BP),and also life threatening bleeding problems after taking wrong dose of warfarin ( a blood thinner used in heart disease).I have often wondered why some doctors write this way. Even those who have reasonably good handwriting, fails to make legible prescriptions. This, I would say is a fatal negligence. The time of secrecy in prescriptions is a long forgotten story. Doctors should be aware that they are answerable for such  negligence and could be held responsible.

A Texas cardiologist was probably the first doctor held liable for a fatal medication mix-up caused by this long time problem of bad handwriting. A jury in Odessa, Texas, ordered Ramachandra Kolluru to pay $450,000 to the family of Ramon Vasquez, who died after a pharmacist misread Kolluru's writing. The 42-year-old heart patient was given the wrong medication at eight times the recommended dosage. Two weeks later, he was dead from an apparent heart attack.

The victim's widow, Teresa Vasquez, says she sued to prompt doctors and pharmacists to be more careful. If the doctors don't change their writing, then it could happen to me again with my kids or even me,'' she says. Now, ''doctors might change, and it might not ever happen again to anybody. We had no complaint about his (Kolluru's) care. In fact, he is a good doctor”

The case points to a growing danger as medications become more numerous and their names more similar. Such cases go unanswered in India, probably because patients do not know they have the rights to complain about this. In the case I had mentioned, the family opted not to complain, and prayed doctors to be more careful.

From prescriptions to physician signatures, and from progress notes to referral letters, bad handwriting is a concern in every aspect of patient care. Pharmacists must be able to read medication orders, nurses must be able to determine whom to ask if they have a question about an order, and other physicians must be able to extract information efficiently from patient charts. In a 1986 study from the New England Journal of Medicine, out of 50 outpatient progress notes, 16% of all words were illegible. Only14% of the 50 outpatient progress notes had legible signature. Poor handwriting by physicians is riskier than poor handwriting by other professionals.

There are simple solutions to a dangerous problem. Many of the doctors can write legible prescriptions, if they take care. An assistant with good handwriting in the physician’s clinic could write the prescription as directed by the physician, then have the physician sign it. The drawback to this being that someone must pay the salary of the prescription writer.

The capability of pharmacists to decipher illegible calligraphy is known as to be almost proverbial. But then, we have another problem. Most of our pharmacies do not have qualified pharmacists. They get the pharmacy licence on someone’s name, but employ salesgirls or boys on low salary who probably have only school education. And on top of all this, more than 30% of all medicines sold are supposed to be fake medicines. Frightening combination, isn’t it?

can you read?

a good example

Bad writing is more like bad manners than
bad features: it is unpleasant to the
beholder, like an ugly face, but, unlike it, is
easily corrigible.
- E.W. Playfair