Writing illegible prescriptions may lead to procurement of wrong medicines that can have life- threatening complications.
If a central government proposal comes into effect, doctors will have to prescribe medicines in capital letters, based on their generic names or chemical formulations, rather than the brand names of pharmaceutical companies that produce the drugs.
Writing illegible prescriptions may lead to procurement of wrong medicines that can have life- threatening complications. For example, a patient at a city-based hospital was recently asked to take Dimol (generic name – Dimethicone), an anti-acidity drug, for his flatulence-related problems.
"The chemist instead dispensed Daonil (generic name – Glibenclamide), an anti-diabetic drug. The patient's sugar levels dropped drastically and he fell unconscious. It took us a while to understand what had happened," said Dr Altaf Patel, head, department of medicine, Jaslok Hospital.
"In another instance, in doctor's jargon, I had written "Ct all", meaning "continue all", in the prescription. The patient was given a urinary alkaliser medicine, Cital, by the chemist. In my view, thus, writing legibly in capital letters will help," said Patel.
Instead of prescribing the anti-biotic drug name, 'Augmentin 625,' manufactured by the pharma company, the doctor will now have to prescribe the generic formulation – amoxycillin and clavulanic acid – in capital letters.
The regulation to preferably prescribe generic drugs has been recommended since 2002, but is hardly followed.
A public notice by the Ministry of Health and Family Welfare (MoHFW) proposes a change in the Indian Medical Council regulations. It reads: "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," reads the notice.
The public can furnish suggestions on the proposed change till August 17 by writing to ali.rizvi@nic.in.
Also, doctors, while prescribing the costlier version of the medicine, often do not disclose to patients that variants of the same medicine are available at less than half the price. "While Augmentin 625 costs close to Rs 250, cheaper versions like Milliclav 625 cost Rs 120. Another brand, Sensiclav 625, which consists of the same components, costs Rs 80," said a senior private practitioner Dr Anil Manerkar.
Patients allege that sometimes doctors prescribe costly medicines in return for favours from pharma companies. On suffering from a severe infection of tonsillitis, 35-year-old Mahadeo (name changed) was prescribed Augmentin 625 (a heavy antibiotic to tackle severe infection) by doctors at KEM Hospital, each pack of which cost him close to Rs 250. Mahadeo, who is a daily wage labourer, earns close to Rs 100 a day. He had to pay through his nose to acquire the tablets from a private chemist outside the hospital.
Even if prescriptions are written in the prescribed format, it finally boils down to what is dispensed at the pharmacy level. So it's important that the medicine finally sold to the patient is in conjunction with the prescription, say researchers.
"It should not be the case that while we ensure that prescriptions are only using generic names, at the level of the pharmacy, the medicines sold are the ones which offer the chemist the maximum profit margin. In case of public health-care facilities, where medicines are provided free, there should be concurrence with prescriptions by doctors in the facility and what is available through government supply," said Anant Bhan, researcher, Global Health and Bioethics.
Varying prices of different brands for similar components in a medicine
Drugs containing amoxycillin and clavulanic acid (used for severe throat and skin infection)
Sensiclav 625 – Rs 80
Milliclav 625 – Rs 120
Augmentin 625 – Rs 250
Pentaprazole-based medicine for severe acidity
Z Pan 40- Rs 25
Pan 40 – Rs 40
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