The High Court of Bangladesh has requested for the government to issue a circular within 30 days, ordering doctors to write prescriptions legibly with wordings either in block letters or in print, after the Human Rights and Peace for Bangladesh (HRPB) presented the court with a writ petition that highlighted the problems faced by patients due to sloppily written prescriptions.

“Sometimes even employees at drug stores fail to read prescriptions and give wrong medicines to the patients,” said HRPB counsel Manzil Murshid.

The High Court bench of Justice Naima Haider and Justice Abu Taher Md Saifur Rahman has ordered the health secretary and Bangladesh Medical and Dental Council registrar to submit a compliance and progress report within six weeks.

Should medications be prescribed using generic names?

The court also issued a rule upon authorities to explain within four weeks, why doctors should not be directed to take effective measures to issue prescriptions with generic names.

According to Murshid, doctors in neighbouring countries write drug prescriptions using generic names in block letters, while health professionals in Bangladesh scrawl brand names on prescription sheets.

A news article that was presented with the petition alleged that some doctors write brand names of medicines instead of generic names, as there is a tacit understanding between doctors and the pharmaceutical companies that influences them to be act with bias.

Consequent to these practices, patients end up purchasing medications that are more expensive despite the availability of cheaper alternatives, or are forced to take medicines that are less potent.

Illegible writing a hazard to patient safety

While the court ruling might seem extraordinary, it is not the first to happen. In 2015, doctors in India were also made to write prescriptions in capital letters to curb the hazard of misinterpretation due to illegible script.

Doctors have often been made fun of due to their infamous association with sloppy handwriting, but the issue is no laughing matter – a 2006 report from the National Academies of Science’s Institute of Medicine in the US estimates that these illegible scripts cause the deaths of over 7,000 patients annually.

The high incidences of mortality are a result of medical errors which stem from misinterpretation of unclear abbreviations and dosage indications. Misplacing a decimal point in the dosage, for example, can result in severe consequences from unintentional overdose.

A study by the Center for the Advancement of Health in 2007 also revealed that a common source of error are illegibly prescribing drugs with similar names, such as celecoxib and citalopram which is a pain medication and an antidepressant respectively – two completely different medicines.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.

Apart from drug prescriptions, illegible handwriting in patient notes and medical records can also lead to a delay in treatment, as allied health professionals are compelled to verify the management plans with the attending physicians.

Misinterpretation of incomprehensible script can also result in unnecessary tests and procedures, administration of medications at the wrong time, misread diagnoses and an array of other errors.

In a more severe consequence however, illegible handwriting in medical records can result in adverse medico-legal implications, with the authors of the study noting that “few admissions look more damaging in testimony than physicians admitting they cannot read their own handwriting. Sloppy handwriting can be interpreted by the jury as sloppy care.”

Implementing computerised system to reduce errors

Computerised systems such as electronic medical records (EMRs), electronic prescriptions and bar-coding technologies have been proposed as methods to eliminate poor handwriting, and prevent any illegibly-written medication names or dosages.

These are in addition to the other benefits of an IT system, which can also prevent faults in dosages through pre-set algorithms that can guide optimal prescription dosages and alert for any harmful drug interactions.

However, many health professionals are still using the pen and paper despite the availability of computerised systems, and until EMRs and other such systems are widely adopted, doctors will need to mind their handwriting to improve patient safety. MIMS

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