Rasananda Bhoi’s elder son died of snake-bite and he expected an ex gratia payment from the Odisha government. When this was not forthcoming, he filed a writ petition before Orissa High Court. Naturally, there would have to be a post mortem, but the judge could not read the doctor’s post mortem report. Peeved,Justice S K Panigrahi observed, “The tendency of writing in a zigzag manner which cannot be read by any common man or a judicial officer has become a fashion among doctors of the state. A substantial number of doctors resort to such handwriting which cannot be read by any ordinary person.
The judge continued, “It is expected that doctors who are dealing with medico-legal issues and writing casually in very poor handwriting, are required to change their attitude and write either in capital letter or in a typed form or in good handwriting so that the judicial system does not suffer from unnecessary fatigue in reading their handwriting.” He issued an order to the effect that the chief secretary should issue a directive to all medical centres, private clinics, medical colleges and hospitals requiring that handwriting in prescriptions and medico-legal reports should be legible. (The doctor appeared virtually before the court and explained what he had written. Rasananda Bhoi’s son had indeed died of snake-bite and he was thus entitled to compensation.)
This order is from January 2024. But this is not the first time the Orissa High Court and Justice Panigrahi have been upset. There was a similar case in 2020, when the court heard the bail application of a man who wanted to take care of his ailing wife. The wife’s medical records were produced, but they were illegible. At that time, the court observed, “Such illegible scrawls composed by doctors creates unnecessary nuisance at the end of the patients, pharmacists, police, prosecutors, judges who are bound to deal with such medical reports.”
This is not a problem specific to Odisha. In 2018, in three separate cases from three separate districts of Sitapur, Unnao and Gonda, the Lucknow bench of the Allahabad High Court fined three doctors Rs 5,000 each because their reports were illegible. The high court observed in Fahad and others vs state of UP, “The doctors have been scribing medico-legal report, injury report, bed head tickets, prescriptions and post-mortem examination reports in such handwriting that it cannot be read by the prosecutor, the defence lawyer or the court.… If such a report is readable by medical practitioners only, it shall not serve the purpose for which it is made. This is despite the fact that computers are available in all medical facilities. In some of the states, practice is being followed where medico legal reports and post mortem reports are made on computers/printers.” Precisely, there are computers everywhere.
Let me mention the September 2016 notification of the Medical Council of India (MCI). “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.” This was added to MCI’s 2002 (Professional Conduct, Etiquette and Ethics) Regulations. There was a reference to generics in 2002 too. But there was no mention of legibility and capital letters. It didn’t seem to be an important issue in 2002, but became one in 2016.
There are several jokes about bad handwriting of physicians. It is standard stereotyping. Naturally, all generalisations are subject to exceptions and I know doctors with beautiful handwriting, a few who still use fountain pens. Everywhere, calligraphy and good handwriting are now at a discount. Indeed, with the switch to digital, conventional writing itself is at a discount. Handwriting has deteriorated for everyone, not doctors alone. As one moves vertically up the career path, it continues to deteriorate. For example, everyone passes exams, entrance or otherwise. With illegible handwriting, despite the emphasis on multiple choice questions, it will be impossible to pass. This is equally true of medical entrance exams. Thus, the problem is subsequent. For other professions, in how many instances do we confront something written by the professional by hand, as opposed to digital? Not too many. Doctors are an exception, through prescriptions and reports, a regular interface. That’s the reason why whenever we think of bad handwriting we think of doctors.
There is a lot to be said for digitising health records and the numbers under Ayushman Bharat Digital Mission are impressive. How many doctors are there in India? If one sticks to allopathic doctors, the registered number is somewhere in the vicinity of 1.3 million. (The number practising must be less.) Think of whichever doctor you go to, and ask yourself, is the prescription printed through a computer? Does the doctor have access to a printer and a computer, even if the doctor is associated with a relatively fancy hospital? I suspect, with a clear urban bias in the responses, the number won’t be that high.
A slightly dated study suggests a primary care consultant—the neighbourhood doctor, so to speak—spends two minutes with the average patient. Ignoring specialists, how many patients does a primary care doctor see per day? Depending on the doctor, and public versus private, the range will be from something like 25 to a number approaching 150. With two minutes or 150, you can’t reasonably expect a neat computer printout as prescription. An illegible scrawl is the default template. Besides, who does a doctor write a prescription for? Traditionally, for a colleague or a pharmacist, not for the patient.
The etymology of the word prescription reflects this and explains why doctors often use mysterious acronyms and abbreviations incomprehensible to patients. This is a bit like lawyers and judges unnecessarily using Latin. Had it been for patients, would expressions like “ac”, “bid” and “qd” have been used? But as patients have become more demanding and as doctors have themselves become unfamiliar with such Latinic abbreviations, their use has declined.
Greater external scrutiny and possibility of litigation and medical negligence cases probably explains why legibility became important to MCI in 2016, though it wasn’t the case in 2002. Did the doctor write Losec or Lasix? There have been actual instances of wrong treatment. Besides, if the hand-written prescription is illegible, which software, or AI, is capable of converting it to a digital prescription?
(bibek.debroy@gov.in)
Bibek Debroy, Chairman, Economic Advisory Council to the Prime Minister