Dr. T. Rama Prasad's Scribblings...: DOCTORS' HANDWRITING MATTERS

OUR (doctors') ILLEGIBLE HANDWRITING

(Help me Mr. Pharmacist. I can't make out what I prescribed in my own handwriting.)

More than half-a-century ago, I used to send “Letters to the Editor” in my own handwriting. Perhaps, this could be one of the driving forces for them to dive straight down into the editor’s waste paper basket !

Illegible handwriting of medical and paramedical personnel is a common cause for errors in treatment leading sometimes to iatrogenic diseases and life threatening consequences. The handwritten prescriptions of many doctors resemble the imprints of ‘a drunken spider falling into an ink well’’ ! They look like a tangled mess of lines and curves.

I wrote in the Indian Express on this matter as long ago as Dec. 6, 1993. Nothing much can be done except to look to the ‘attached medical shop man’ who only can decipher the ‘Greek & Latin ’ in the prescriptions ! Many jokes are in currency about bad handwriting of doctors, in general. The following is an extraordinary composition of an interesting sentence about doctors’ handwriting:

“I do not know where family doctors acquired illegibly perplexing handwriting; nevertheless, extraordinary pharmaceutical intellectuality counterbalancing indecipherability transcendentalizes intercommunication’s incomprehensibleness.”

The above sentence has 20 words. Sequentially, the next word is longer by one letter. The first one (I) consists of one letter. The second one (do) has 2 letters. The third one (not) has 3, and so on. Finally the 20^th word (incomprehensibleness) has 20 letters !! Amazing ? NE

NEET & HANDWRITING

Curiously, handwriting matters little in the case of examinations like NEET. Notwithstanding, the younger generation of doctors, generally, have better handwriting than us, we old fossils ! We were admitted into a school only at the age of five, whereas the present day kids are registered for pre-LKG soon after birth ! And their first lessons start on electronic screens !

IMPRACTICABLE REGULATIONS

In day-to-day practice, I ask my new patients: "What medicines have you been taking ?" They often pull out a bunch of prescriptions. Often, I can't make out anything. Pretending that I understood every word of the scribbles, I move on !

At last, to end the risk posed by illegible handwriting, the Medical Council of India at its General Body meeting in New Delhi on March 28, 2014, approved draft notifications mandating doctors to use only capital letters in prescriptions and has forwarded the draft to the Union Health Ministry for endorsement on June 9, 2014 ( http://www.thehindu.com/news/national/andhra-pradesh/courts-prescription-for-doctors/article6268646.ece ). “The Centre has amended rules in Indian Medical Council Regulations 2002, directing physicians to prescribe drugs with generic names in legible and capital letters, the Lok Sabha was informed today (Dec 5, 2014)” (http://www.thehindubusinessline.com/economy/policy/doctors-will-now-write-generic-drugs-name-in-capital-letters/article6664952.ece#comments ). And the Indian Medical Association (IMA) has passed a resolution that all IMA members “shall write drugs with chemical or generic name in capital letters, and the name of the pharmaceutical company or the brand in brackets.” ( http://www.thehindu.com/news/ima-asks-doctors-to-prescribe-cheapest-version-of-drugs/article7099677.ece; / http://indianexpress.com/article/cities/pune/prescription-in-all-caps-medical-fraternity-gets-the-chill/ ).

Indian market is flooded with myriads of safe and unsafe ‘fixed dose combination drugs’ which are prescribed widely ( http://www.thehindu.com/sci-tech/india-flooded-with-unsafe-fixed-dose-combination-drugs/article7227916.ece ) .

Which doctor is going to write all the generic names in the ‘combination’ drugs in capital letters ? For example, instead of writing ‘SUPRADYN’ one has to write more than forty words to name the twenty generic ingredients that go into the making of the tablet. It remains to be seen how all this would work out. As is the case with many other regulations and legislations in India this also may remain on paper only.

Again in 2023, there was a notification, by the National Medical Commission, requiring doctors to prescribe drugs using generic names WRITTEN LEGIBLY. Among other regulations is the bar on doctors to attend conferences sponsored by drug companies. In an article published in the British Medical Journal, Dr. Kamran Abbasi and Dr. Richard Smith asked : "How did we reach the point where doctors expect their information, research, education, professional organisations, and attendance at conferences to be underwritten by drug companies ?" This sums up the problem, the solution and the 'pharma-doc nexus' ! For more on this subject, click on : https://drtramaprasad.blogspot.com/2017/04/medical-conferences-clinical-meetings_30.html ; https://drtramaprasad.blogspot.com/2017/04/hydroxychloroquine-hcq-and-coronavirus_29.html

Handwriting. Which hand is writing !!!

The scribbles of doctors look different to different people like UFOs (Unidentified Foreign Objects coming from the outer space) !!!

This is how a doctor with a bundle of certificates from high-end schools and world-class universities wrote out a prescription for ASPIRIN !!!

On the contrary, you can see below the handwriting of our receptionist, Hema, who didn't go through even the drill of handwriting in a school or at home. Beautiful handwriting, even when it was written hurriedly. It seems to be a god's gift.

HANDWRITING

Handwriting may mean more than what it literally conveys. It is claimed that by analyzing handwriting one can know about various facets of personality such as innovative, intellectual and creative abilities; about one’s integrity, aptitude, grit and determination to succeed; about communication skills, personal drive and productivity; about vulnerability to stress, fears and inhibitions, to name a few. This scientific branch of study is called Graphology which is used in European countries such as France, Germany, Italy and Spain for personnel screening, personality evaluation and vocational guidance. It is also useful in psychology and criminology.

Interestingly, while we condemn the illegible handwriting of many and recommend typewriting to minimise errors, voices are there lamenting the loss of glory of handwritten matter. Mr Philip Hensher, in his new book, “The Missing Ink: The Lost Art Of Handwriting (And Why It Still Matters)” expressed that “to diminish the place of the handwritten in our lives is to diminish, in a small but real way, our humanity.” Yes, he is right. Handwriting has a human touch and an individual character with emotion. Computers are generic and bland with a cold and clinical face. And recently "ARTIFICIAL INTELLIGEENCE (AI) has come in to make us brainless !!!

This is the reason why I still prescribe by my own handwriting though I have computer facilities to rollout prescriptions. The photo below was taken on August 22, 2024 while I was writing a prescription. The handwritten prescriptions have a personal touch and an individual responsibility.

SNAIL MAIL AGAIN !

In those good old days, people used to have pen pals (penfriends). I too used to have some pen friends whom I never met. It may be news to many that now a group of youngsters called “The Goodwill Tribe,” spread over different cities in different countries are set to recreate the art of handwritten letter writing but with a difference. The receiver of the letter would not necessarily know the sender. The sender is a volunteer of the group who gets the contact address of a needy person through any of the members of the group, writes a positive message of love and hope, puts it in an envelope and posts it to the receiver. And so the correspondence goes on. Reach Out: thegoodwilltribe.org

WRITING ON PAPER

A recent (2021) study showed that we learn and remember information better when we write down on paper rather than seeing on digital screens (Frontiers in Behavioral Neuroscience). The unique, complex, spatial and tactile information associated with writing by hand on physical paper improves memory. Actually, the paper is more advanced and useful compared to electronic documentation for storing details in the human brain. The take-home message is to use paper notebooks for information we need to learn and memorise.

MEDICAL REPRESENTATIVES

When I was a schoolboy, I used to look at medical representatives with awe and admiration for their impeccable attire, pleasant manners and fluent communication in English when they used to visit my doctor father. I used to think that I should become one like that. Anyway, I landed in a related profession and have been enjoying seeing them daily. It is a wonderful profession which provides them the knowledge of good and bad in medical and pharmaceutical fields as they have the opportunity to visit numerous hospitals and innumerable number of doctors. In fact, we doctors don't know that much as we are like frogs in a well. They provide us 'brand names' printed so clearly on attractive brochures, while we doctors scribble the brand names often indecipherably.

"In this DIGITAL ERA, it is hard to find the badness of a doctor's HANDWRITING."

-- Dr. T. Rama Prasad