The im­por­tance of pre­scrip­tion leg­i­bil­ity

Hindustan Times (Delhi) - - METRO - PUSHPA GIRIMAJI

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.

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