Introduction
Illegible handwriting by medical professionals has been identified as one of the leading causes of medical errors.1 Sometimes, these errors lead to severe injuries or death. There has been an ongoing debate on whether sloppy handwriting is a deliberate act by medical doctors to discourage self-medication. However, some medical practitioners have argued that bad handwriting is not exclusive to the medical profession. They also contend that doctors' handwriting is poor because they hurriedly scribble so they can have enough time to attend to the numerous patients they see daily.2 Whether done intentionally or not, there is a consensus that illegible prescriptions are causing avoidable injuries and deaths.3 The aim of this article is to argue that poor handwriting by healthcare providers conflicts with the duty of care they owe patients.4
The Role of Handwriting in Medical Practice
The usual practice is for medical doctors to prescribe medication for treatment after diagnosis and/or tests. Such prescriptions, usually handwritten, are what pharmacists and nurses interpret to determine the type of medication to dispense or administer to patients. In some cases, doctors rely on medical records earlier written by their colleagues to decide how to manage patients. The danger is that while the medical professional with the sloppy handwriting may not find it difficult to understand what he wrote, the same cannot be said for third parties who interpret what has been penned down. Consequently, third parties relying on such illegible prescriptions or medical records occasionally misinterpret them and administer wrong treatments or medications, thereby endangering the life and well-being of patients.
The Global Impact of Illegible Prescriptions
It has been established that injuries and deaths caused by errors linked to illegible handwriting by medical professionals, especially doctors, are increasing globally. According to the Institute of Medicine in the United States (IoM), illegible handwriting alone accounts for 7,000 out of the approximately 44,000-98,000 preventable deaths caused by medical errors annually. The Institute also reported that such preventable medication mistakes cause injuries to more than one million Americans annually.5 Medscape India, a non-profit organisation leading a campaign on this issue, reports that fatal incidents caused by doctors' illegible prescriptions are increasing worldwide.6
In response, countries have been advised to introduce electronic medical records (EMRs) and computerised physician order entry (CPOE) systems to reduce the risk associated with handwritten prescriptions. These digital solutions aim to minimise misinterpretations and enhance patient safety.
Illegible Handwriting and Medical Negligence
Even if poor handwriting by medical professionals is not deliberate, it should be emphasised that their obligation to exercise the highest degree of care while dealing with their patients makes it incumbent on them to write legibly. This is because where a patient suffers an injury that can be attributed to illegible handwriting, it may be a viable cause of action in medical negligence. The fact remains that a reasonable person in the position of a medical professional would know that there is a risk of misinterpretation of an illegible prescription or record.
It is even more concerning when the pharmacist, nurse, or doctor who is uncertain about what is written in the prescription or medical record proceeds with the dispensation or administration of medication or treatment. A prudent professional in such circumstances would either seek clarification from the author or decline to dispense treatment or medication when the author is not reachable.
In Prendergast v Sam & Dee Ltd,7 a doctor wrote a prescription for "Amoxil" (amoxicillin), but due to illegible handwriting, the pharmacist misread it as "Daonil" (glibenclamide) and dispensed the wrong medication. The patient, not being diabetic, suffered permanent brain damage after taking the incorrect drug. The UK Court of Appeal held both the doctor and the pharmacist liable, attributing 25% of the responsibility to the doctor for failing to write legibly, and 75% to the pharmacist for not verifying the unclear prescription.
Similarly, in Teresa Vasquez et al v. Dr. Ramachandra Kolluru,8 decided in 1999 in Texas, USA, Dr. Kolluru prescribed Isordil for his patient, Ramon Vasquez, but due to illegible handwriting, the pharmacist misread it as Plendil and dispensed the incorrect medication at an excessive dosage. Mr. Vasquez suffered a heart attack and died shortly thereafter. The jury found both the doctor and the pharmacist liable, awarding $450,000 in damages to Mr. Vasquez's family.
Possible Solutions and Best Practices
To address this issue, healthcare institutions and regulatory bodies must implement policies that encourage or mandate the use of electronic prescriptions. The adoption of electronic health records (EHRs) and digital prescription systems has been shown to significantly reduce prescription-related errors.9 Where handwriting remains necessary, medical professionals should be trained to improve the legibility of their writing. Additionally, a verification system should be in place where pharmacists and nurses must seek clarification before administering medications or treatments.
Furthermore, medical institutions should incorporate handwriting training into medical school curricula and encourage a culture of accountability among healthcare providers. In addition, legal frameworks should be strengthened to ensure that cases of medical negligence due to illegible handwriting are appropriately addressed. Patients and their families should also be aware of their rights and avenues for legal redress in cases of harm caused by prescription errors.
Conclusion
Illegible handwriting by medical professionals poses a serious threat to patient safety and conflicts with their duty of care. Whether intentional or not, the consequences of misinterpreted prescriptions or medical records can be life-threatening. The medical community must take proactive steps to mitigate this risk by embracing digital solutions, enforcing accountability, and ensuring that healthcare providers uphold the highest standards of professionalism. By addressing this issue effectively, the healthcare sector can prevent avoidable injuries and deaths, ultimately fostering a safer and more efficient medical practice.
Footnotes
1 Yimeng Zhang, Nicole Marie Zerafa, Simon Paul Attard Montalto, 'Student and doctors' handwriting on a pre-set prescription: how great is the potential for medical error?' (Malta Medical Journal, 2020) https://www.mmsjournals.org/index.php/mmj/article/view/325 accessed 24 February 2025.
2 Idowu Abdullahi, 'Doctors give reasons for bad handwriting as patients struggle to understand prescriptions' (Punch, 9 February 2025) https://punchng.com/doctors-give-reasons-for-bad-handwriting-as-patients-struggle-to-understand-prescriptions/#:~:text=There%20is%20a%20misconception%20that,what%20we%20have%20in%20mind. accessed 24 February 2025.
3 Tessy Igomu, 'Death by prescription: How doctors' sloppy handwriting causes avoidable drug dispensing errors' (Punch, 17 January 2021) https://healthwise.punchng.com/death-by-prescription-how-doctors-sloppy-handwriting-causes-avoidable-drug-dispensing-errors/ accessed 24 February 2025.
4 For an elaborate discussion of the concept of medical negligence, see the article titled: 'An Overview of the Concept of Medical Negligence In Nigeria' by Queen Ukpo and Obruche Koski available at https://compos-mentis.com/an-overview-of-the-concept-of-medical-negligence-in-nigeria/.
5 Jeremy Caplan, 'Cause of Death: Sloppy Doctors' (Time, 15 January 2007) https://time.com/archive/6931958/cause-of-death-sloppy-doctors/ accessed 24 February 2025.
6 Tessy Igomu (n 3).
7 (1989) 1 Med LR 36.
8 Ector County (TX) Destrict Court. Case No. A-103,042 cited in Davide M. Benjamin, 'Reducing Medical Errors and Increasing Patient Safety: Case Studies in Clinical Pharmacology' 16 https://discovery.researcher.life/download/article/4fe93ad6977f3283b53e8403101f940e/full-text accessed 25 February 2025. See also BBC News, 'Health Doctor's scrawl blamed for patient death' (15 November 1999) http://news.bbc.co.uk/2/hi/health/521157.stm accessed 24 February 2025.
9 Emily Beth Devine and others, 'The impact of computerized provider order entry on medication errors in a multispecialty group practice' (PubMed Central) https://pmc.ncbi.nlm.nih.gov/articles/PMC2995630/ accessed 25 February 2025.
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