The controversy over the handwriting of doctors is centuries old. , Photo credit: Getty Images/iStockphoto
DActors have unique ways of communicating with others. Apparently, through years of grueling training, hectic work schedules and being provided with few ways to talk during their education, doctors have developed esoteric methods of communication. Typical examples are the notes in their prescriptions and case sheets, which are often understood only by the doctor’s nurse or the local pharmacist. The moment it goes outside the purview of a doctor’s practice, it becomes an esoteric document. Many doctors themselves have trouble understanding other doctors’ handwriting, which leads to confusion and uproar.
I once hired a psychiatrist for an orthopedic patient under my care, and when I read it the next day, I cringed. In the progress note, he had written only one line in mysterious handwriting – The patient was warm in bed. As the patient smiled naïvely at me, I scratched my head thinking of the infinite possibilities and impossibilities of such an event, given that this was a typical ward of about 20-odd patients. Later I came to know that when she went to meet him, the patient was not on his bed. Jokes apart, incomprehensible prescriptions are a serious cause of medical errors jeopardizing the safety of the patient’s health and well-being.
In many instances communication between doctors is also anecdotal and end-to-end ‘encrypted’. Medical abbreviations are liberally used in clinical practice, which are not standardized and universal. To give an example, the abbreviation PR is commonly used for two medical things – pulse rate and per-rectal examination. Pulse rate (PR) is assessed by placing your fingers on the patient’s wrist and counting the number of pulses felt in one minute. It is a simple appreciation and is, in fact, a soothing gesture that improves the relationship between a patient and a doctor. Whereas per-rectal examination (also abbreviated as PR) is a slightly painful experience for the patient as the doctor inserts his gloved finger through the patient’s lower extremity to feel some of the internal organs.
An intern was once reprimanded by his professor because he clearly failed to understand when he was instructed to check PRs every 15 minutes for two hours and report back to the professor. Obviously, the intention of the well-intentioned professor was only to continuously check the patient’s pulse rate.
There are many informal medical abbreviations such as MR which may mean mental retardation, mitral regurgitation, magnetic resonance or medical representative depending on the context. Due to time constraints and the urgent demands of work, the use of such colloquial abbreviations and acronyms has entered medical practice along with a burden of problems and miscommunications. With current generations’ penchant for abbreviations such as LOL, ROLF and B4, and the frugal use of words in social media, the use of abbreviations and acronyms in medical practice has become widespread. For a patient with multiple medical ailments, a new medico has written k/c/o DM/HT/IHD/CLD/MRD which means the patient is a known case of diabetes, hypertension, heart, liver and kidney diseases . , leaving me saying OMG. In the case of notes and prescriptions, documentation should avoid short forms, non-standard abbreviations, and a clear handwriting should be encouraged. This is easily said given the poor doctor-population ratio and the increasing workload of doctors.
Doctors also use medical jargon during discussions with patients. This is often unintentional, as the terms are so familiar to doctors that they do not consider it technical when the patient may hear it for the first time. Sometimes, it may be used interchangeably due to the lack of equivalent non-medical terms. It is inherently difficult to translate medical terms for diseases into easily understood non-medical terms. Furthermore, explaining an illness in the local language can be a double-edged sword as it is impossible to fully understand an illness on a brief consultation, and half-truths can be more inconvenient and destructive. The use of non-medical terms for diseases is also not standardized, and different doctors use different terms for the same disease, often confusing patients. For a disc herniation, a number of terms such as disc prolapse, slipped disc, bulge, swelling, rupture and degeneration, and an equal number of shocking non-medical terms are used in the regional language. It is difficult to draw lines here but the intention should be to make the patient understand and feel comfortable. There is no single standard recipe for improving communication between doctors and patients. It should be individualized and an active effort should be made to address inconsistencies in medical language.
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