Horror as doctor’s handwriting almost costs a life. It was during this time, three years ago, that he cheated death after a pharmacist dispensed to him wrong medication after misreading a doctor’s prescription. For Ruramai Dzeka (45), who has a long-standing condition known as cardiac arrhythmia that causes irregular heartbeat, the month of October always evokes bad memories.
Dzeka was served with Metformin Hydrochloride instead of his usual prescription of Rythmol, an anti-arrhythmic medication, which he had used for five years to manage his condition. Metformin Hydrochloride is a drug used to treat diabetes mellitus, a condition in which the body cannot control the level of sugar in the blood.
“Shortly after taking the medication, I began to feel weak, with nausea, sweating and increased irregular heartbeat,” he said. “These symptoms persisted for weeks and the last thing I remember was an ambulance taking me to hospital after the situation worsened.
“When the doctor saw the medication I was taking, he was shocked and immediately revealed that it was the wrong prescription.” When the doctor confronted the pharmacist who had dispensed the prescription, it became apparent that a medical gaffe had occurred.
The pharmacist had failed to decipher the doctor’s handwriting on the original prescription. “I was at my wits’ end. To this day, there are occasions when I feel the effects and symptoms I felt when I took the wrong medication.” For many, including some trained medical professionals, deciphering the scribbles on some doctors’ prescription note pads often proves a Herculean task. Many have concluded that doctors are generally flawed writers.
Questions have been asked about whether doctors deliberately write unintelligibly as a means of discouraging patients from prescribing their own medication. Others have concluded that bad handwriting is an innate gift peculiar to doctors.
Whatever the reasons, the dangers posed by illegible prescriptions can mean the difference between life and death. A study by Medscape, an India-based organisation spearheading a global campaign to reduce fatalities caused by illegible prescriptions, concluded that this phenomenon is on the rise.
A 2006 National Academies of Science’s Institute of Medicine Study in the United States of America found that 20 percent of prescriptions were unreadable or readable only with effort. “Doctors write about 3,2 billion prescriptions annually, but poor handwriting on such notes leads to over 7 000 deaths and 1,5 million medical errors,” reads part of the research.
The study noted that many such errors result from unclear abbreviations and dosage indications. A standard prescription should show three basic things: the prescribed medication; dispensing instructions and the patient instructions.
Harare-based general practitioner, Dr Norman Njobvu, said millions of lives are potentially in harm’s way on account of illegible prescriptions. “Illegible handwriting can delay treatment and lead to unnecessary tests and inappropriate drug doses, which, in turn, can result in discomfort or death,” he said.
“When a patient is referred to my hospital and the accompanying notes are unclear, I usually place a call to the doctor for verbal clarification.” Dr Njobvu said the situation was rampant in public hospitals. “In private practice, it is not common because it would do more harm than good to the hospital’s reputation,” he said.
“In some cases, when an illegible doctor’s prescription is taken to a pharmacy, the pharmacist could just give drugs based on the symptoms presented by the customer. This is totally wrong.” Dr Njobvu said after being presented with a prescription, a pharmacist is expected to dispense, advise, recommend and even ask questions where necessary.
Unhealthy rivalry
However, he said the problem is compounded by the souring of relations between doctors and pharmacists characterised by an unhealthy rivalry that has developed over the years.
“Pharmacists now refer to themselves as ‘PharmD’ (a combination of a pharmacist and a medical doctor). They now see themselves as doctors and even prescribe drugs,” said Dr Njobvu. “Even laboratory technicians are now prescribing medication.
“In an organised setup, you can only buy over-the-counter drugs without a prescription and all prescription drugs are can only be bought after presentation of a genuine signed and stamped doctor’s note.” Data on patients who have been dispensed the wrong medication in Zimbabwe is unavailable.
Medical and Dental Private Practitioners Association (MDPPZA) president Dr Johannes Marisa said prescribing the wrong medication can lead to death, or financial liability for the doctor and possibly the hospital. “Although this has been rampant for so many years, it does not constitute malpractice on the part of the doctor, but they should be extra cautious,” he said.
“A pharmacist should not dispense something that they cannot read.” Dr Marisa added that a pharmacist who dispenses wrong medication on account of unclear handwriting can be charged with malpractice.
Pharmacists not culpable
Community Pharmacists Association secretary Mr Luckmore Bunu said a pharmacist must be satisfied with the handwriting on a prescription before dispensing medication. “If he/she is not able to read a prescription, he/she can request the prescriber to rewrite the prescription legibly,” said Mr Bunu.
“Notwithstanding a patient’s right to health as enshrined in Section 76 of the Constitution of Zimbabwe, a pharmacist is allowed at law to refuse to dispense a prescription if he/she cannot read what the prescriber has written.” He added: “We are not aware of studies that have been done in Zimbabwe to ascertain the frequency of dispensing errors due to illegible prescriptions.
“However, in a study done in South Africa by Brits et. al. (2017), pharmacists read the (handwritten) prescriptions worst among other healthcare workers. “In a similar study in Switzerland, 2,52 percent of the prescriptions were rated as having bad handwriting and 4 percent as unreadable.”
He said pharmacists are competent professionals who take necessary measures to ensure that patients receive correct medication. “As such, it is highly unlikely that patients will be given wrong medications.
“In the event that it so happens, there are checks and balances that have been put in place to avoid unnecessary loss of lives.” Pharmacist, Mr Enock Mukweva, said: “A pharmacist does not just assume. No trained, qualified pharmacist would dispense a prescription that is not comprehensible.”
Source – Sunday Mail
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