Poor handwriting

What to do about the seemingly intractable problem of poor handwriting among some healthcare staff.

Not long ago the MDDUS had a visit from the Deputy Scottish Public Services Ombudsman, Eric Drake, who took part in an open forum with our Medical and Dental Advisory Teams. One topic that came up in discussions was that of the seemingly intractable problem of poor handwriting among some healthcare staff.

An age-old staple of doctor gags, unclear and illegible writing still features regularly as a factor in complaints to the Ombudsman's office, as well as in more serious cases. One classic instance was that of an American cardiologist whose prescription for 20 mg of the antianginal drug Isordil was misread as Plendil, an antihypertensive. This led to the death of 42-year-old patient. Another recent case was that of a nurse at Monklands General Hospital who misread a colleague's notes and administered 40 units of insulin to a patient rather than the 4 units intended. The 62-year-old patient died of bronchial pneumonia following brain damage and cardiac arrest due to the insulin overdose.

Poor and illegible handwriting is bad practice in both professional and clinical terms. Much is promised of 'paperless practice' with palm-top computers and ePrescriptions but at present most notes are still handwritten. In an age of healthcare provided by multi-professional teams, written notes are the prime means by which vital clinical information is transmitted among staff. Should a doctor, dentist, nurse or pharmacist be unable to read entries in a patient's notes or a script there can be no certainty about the safe transfer of data. Deciphering notes can be frustrating and time-consuming, and can lead to risky guess work when the original author is unavailable. It can lead to unnecessary and inappropriate tests and treatment delays.

The medico-legal implications are obvious. It can be an embarrassing experience to witness a doctor struggling to read entries in hospital or general practice records while giving evidence in court. Worse still when it's his or her own notes. The GMC has said it will not tolerate poor handwriting and it could be viewed as an element in impaired fitness to practise.

ACTION: write legibly. It's an obvious thing to say short of the penmanship classes offered in one American hospital. Take time to ensure notes are readable - writing quickly is a false economy. Assess the legibility of your own handwriting and ask the views of colleagues. Should improvement in handwriting seem impossible then consider dictation or typing instead.