The importance of prescription legibility
Do you know what ‘b.i.d’ means in a doctor’s prescription? Or for that matter, ‘q.d’ or ‘t.i.d’? Well if your answer is that it’s all Greek to you, I would not blame you. These are all abbreviations of a foreign language — Latin — and obviously incomprehensible to most consumers.
For example, ‘q.d’ stands for ‘quaque die’ in Latin, meaning once a day. Meanwhile, ‘q.i.d’ stands for ‘quater in die’ or ‘four times a day’. Yes, even if you understood the abbreviations, if you got the alphabets wrong because of the poor handwriting of the doctor and mistook ‘q.d’ for ‘q.i.d’ and took a tablet four times a day instead of once, it could be well be disastrous. The letters ‘b.i.d’ stand for ‘bis in die’ in Latin, meaning ‘twice a day’; and ‘t.i.d’ stands for ‘ter in die’, meaning ‘thrice a day’.
As it is, most doctors’ prescriptions are difficult to follow, because of bad handwriting. Even pharmacists who are adept at deciphering doctors’ recipes, sometimes fail to get it right, leading to serious medication errors. The use of Latin abbreviations makes matters worse. So it’s time we stopped clinging to these outmoded, unintelligible acronyms and adopted a simple, easily understood way of conveying the crucial information.
Besides standardising simple English, the Medical Council of India (MCI) should recommend pictorial representations, as a sizeable number of patients in India do not follow English. Some doctors for example, indicate the number of times a medicine has to be taken, with dots or small zeroes. One zero for once a day, two with a space between them for twice a day, etc. This is easily understood by all and it is time such changes are introduced.
In the last couple of years, the MCI and the state medical councils have tried to promote a standard prescription format. There is also an attempt to promote generic drugs and prevent prescription errors by asking doctors to write legibly and in capital letters. The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, says that: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.” (1.5, Chapter 1, Code of Medical Ethics)
Yet, doctors continue to prescribe brands and most often their prescriptions are difficult to understand. The Allahabad High Court’s decision last October to impose a penalty of ₹5,000 on three doctors for their illegible handwriting, is a case in point. What annoyed the judges was that in three separate criminal cases, the poor handwriting of doctors had rendered injury reports of victims unintelligible.
The doctors’ defence was the heavy workload — in fact doctors in government hospitals say that the pressure of work is such that it does not allow them to spend more time on the prescription. However, a badly scrawled prescription can be counterproductive, if it is misread and can lead to medication error, with serious consequences on the health of the patient.
In order to overcome the problem of indecipherable prescriptions, many countries around the world are moving to electronic prescriptions and we, too, need to do that, particularly because e-prescriptions also allow use of local languages and one can do away with acronyms. But, the software should be such that the process is less time consuming than writing out a prescription.
And till we move towards that perfect solution, make sure that there is no confusion about what the doctor is prescribing. Cross check the generic name of the drug, its purpose, dosage, how and when it should be taken and the side effects, if any. Remember, the apex consumer court has upheld the patients’ right to all vital information about the prescribed drug (Dr VK Ghodekar vs Sumitra Prahlad Korgaonkar, RP NO 1727 of 2002).
The MCI has been trying to promote a standard prescription format for the past few years.