CAPITALS AND COMPREHENSIBILITY

World is changing and so are the practices. Uniformity in practices in the variable world to achieve a basic minimum standard appears to be the key at least in the medical world to ensure safety. Some rule/guideline made in some corner of the globe has its global implications. While some are really beneficial, few are really painful and incomprehensible. One such really painful thing I feel is prescribing medications in capital letters. I do not know how this rule came into existence. The basic idea is that the prescription has to be comprehensible. Doctors' handwritings are very infamously illegible. It appears to be a global phenomenon, though the reason behind is yet to be ascertained. Anything which is done with disinterest will lead to inappropriate outcome. I presume that most doctors loose their handwriting quite early in their career when they are forced to document heavy case notes of patients - doing more clerical than clinical work. To overcome this incomprehensibility a CAPITALS ONLY rule has emerged, probably designed in one of the capitals, thankfully limited to prescription of medications. Are we then not bothered how the remaining notes are made more legible? Do we not risk wrong communication and hence wrong treatment when written illegibly in the remaining part of the case notes?

We need to understand that there are certain presumptions made when this rule was designed.

1.      Majority if not every doctor on this earth has a really bad incomprehensible handwriting

2.      Writing in capitals makes it more comprehensible than in small letters

3.      Most prescriptions are written in English.

Let's see each one of them one by one.

1.      Not every one has a bad handwriting. At least 50% have a reasonable handwriting, which is readable and comprehensible by many. It is probably insulting to force these people to write in capitals when they are doing a reasonably comprehensible job. But again these are the casualty of the eternal search for uniformity in practices or probably the copy/paste culture.

2.      What makes capital letters more legible than small letters is incomprehensible to me till date. It just takes to be more careful when prescribing keeping in mind the consequences of either dispensing or administering wrong medication due to illegible writing. All said and done, more time is consumed when writing in capitals than in cursive. Enforcing the capital rule, puts us in a situation where in by design it keeps the doctors longer in the disinterested work while the doctor is in a hurry to finish the job sooner risking the capital letters of becoming dangerously incomprehensible. What would be the solution then? I think sometimes it is a systematic discrimination against small letters.

3.       English is a language written in capital as well as small letters. What if we were prescribing in Indian languages which do not have the luxury of writing the same alphabet in more than one ways? Thankfully, there is no way that we implement this capital rule in Indian languages. How then can one make the writing in these languages more legible other than being careful? Care and empathy is the underlying requirement where as this capital rule is just a surrogate.

So logically it seems to me that that one can easily refute the claim that capital letters are more legible than small letters. But who knows, there may be evidence lurking around in the medical literature just to prove the opposite in this evidence based medical world we live in!!