At a social gathering a friend of mine related an astonishing experience he faced. Being journalists we were very eager to listen to it as curiosity is inherent to our ilk. “I went to a doctor to take treatment for migraine and took the prescription to the nearby pharmacy. I continued the drug for nearly one month. In the meantime, a doctor friend visited me and seeing my medicine queried why I was taking this medicine. When I replied I had migraine, he was shocked and said: “Are you mad, this medicine is given for mental disorders,” he related.
This is another unfortunate incident faced by another friend. He had gone to a doctor to take treatment for his daughter. He said: “When I went to the pharmacy, the pharmacist realized an error in the dosage of the medicine prescribed and immediately contacted the doctor and dispensed the proper dosage. Only vigilant and knowledgeable persons can spot these serious and fatal errors in medical care. Apart from the amusing aspect in these anecdotes, it highlights the danger of people meekly taking the medicine dispensed to them without question. These are fatal mistakes that put the life of patients on the line”.
Incidents of deaths due to drug allergies and misadministration of injections are replete. These miscarriages of medical treatment are normally forgotten over time due to the absence of a strong civil society challenging these lapses. Want of a strong forum to discuss patients’ rights is the main cause for these unfortunate incidents.
In developed countries, the patient is also a strong stakeholder in medical care and there are powerful mechanisms to safeguard patients’ rights. There was a media report once that a patient sued a doctor for medical negligence in a developed country and obtained a colossal amount as compensation because the doctor advised him to rest at home keeping away from his business for three months as he was critically ill. The doctor was accused of misdiagnosing his sickness as he was later diagnosed not so seriously ill, which had resulted in him losing business income for a long period. The court held that the patient’s claim was reasonable and awarded compensation from the doctor. Such mechanisms to safeguard patients’ rights are not in our statute.
When browsing the internet this writer came across a research article compiled by a team of eminent Sri Lankan doctors titled ‘Investigation of Medication Errors: A Prescription Survey from Sri Lanka’. This research article focused on data analysis of hand-written medical prescriptions issued by local western doctors. This report analyzed 200 prescriptions collected from locations in the Aluthgama Urban Council limits in the Western Province and the Kandy Municipal Council limits in the Central Province. The research highlighted serious errors in the medical prescriptions such as the name of the patient, age, sex, the name of the doctor, his registration number and signature, medical abbreviations and date of treatment. The details in the prescriptions were much below par. For example, writing a part of the name or incomplete name or mentioning only the surname or paying no attention to patients’ age causes confusion among pharmacists as well as patients, the report emphasized.
Of prescriptions examined 36.5 percent did not conform to international standards. The reports underscore that 51 percent of the prescriptions were either incomplete or incorrect. The report draws serious attention to the lack of conformity to international standards of medical practices and out of 200 only 99 were legible showing 49.5 per cent. There were limitations to this study, but one is able to form a rough opinion on overall medical prescription practice. The serious deviation from recognized practices of high standard in prescription writing is at the bottom of this confusion, reiterates the report.
The confusion is further compounded by the haphazard usage of abbreviation and units.This writer recently met Dr. Priyadarshani Galappathi, Professor of Pharmacology of the Medical Faculty of the University of Colombo to discuss about the importance of issuing error-free
medical prescriptions which otherwise put a patient’s life at risk and the misreading or wrong dispensing of medicine may be the death warrant to the patient.
“I admit that there are issues in writing prescriptions. In advanced countries patients receive computer-generated prescriptions which are highly error-proof. In Sri Lanka, due to lack of funds we cannot implement such a state-of-the-art mechanism in state hospitals. But on the whole, harm caused to patients due to issues in prescriptions is only minimal in medical treatment. The safe usage of drugs is still a challenge we have to overcome. This is a worldwide phenomenon.
“Mortality rate is on the rise even in developed countries due to shortcomings in the medical care. Latest reports reveal that 180,000 patients die annually in America but unofficial reports indicate the figure is around 400,000. Out of this, 50 to 78 per cent is preventable. One in 300 dies in UK hospitals due to medical lapses. The situation in our country might be much worse when compared to developed countries,” Dr Galappathi remarked.
She went on to explain that human errors could be caused at various stages of treatment. For example when doctors write prescriptions, pharmacists dispense drugs, nurses write drugs on bed tickets or if a patient occupies another patient’s bed.
According to my experiences in the UK, there is a pharmacist in every ward of any hospital who monitors administering of drugs to patients and recheck with the doctor in case of doubt. Such a practice does not exist in our hospitals.Though pharmacists graduate from our four universities annually, there is a shortage of qualified pharmacists in pharmacies.
Normally pharmacies are overcrowded and pharmacists find it difficult to double check the prescriptions. Some patients do not have an inkling of the name of the drug they use even for a long period and identify the drugs by their size or colour.
The doctor says she always insists on her students to prescribe drugs by generic names as there are more than thirty to forty patent names for a single drug which at times lead to confusion.
There are some corrupt doctors, on the payroll of the drug mafia, who prefer to prescribe expensive drugs by patent names which are available at low prices.
Serious attention should be paid to storing drugs in methodical manner as there are drugs which have nearly similar names whose names differ only by a letter or two which may lead to mix-ups.
“In other countries there are methodologies to detect medical lapses but in our country these are not reported”, lamented Dr Galappathi who suggested a procedure to implement in order to avoid such shortcomings.
Some patients hide their sickness from the doctor or they do not reveal all their problems or some even hide their pregnancy. If the doctor is not well briefed he or she cannot prescribe the most suitable medication.
“In my opinion, all the stakeholders in medical care such as doctors, nurses, pharmacists or even patients should cooperate to raise the standard to avoid any lapses,” she said.
It is high time to raise the awareness of patients’ welfare. The health service of our country is in a mess due to political interference and undue influence of the international drug mafia. Patients suffer as a result of this outcome. The wellbeing of the patient lies mainly on him and not solely on the doctor. Dr Galappathi advises patients to organize better to take on the challenges they face.