Once upon a time, I used to have very neat writing, but medical school, surgical training, and the endless beauraucratic paperwork has beaten it out of me by the time I have become a fully qualified specialist.
My writing got so bad – that this week, when I left my husband a shopping list of things I needed urgently, I got a surprise in return. The list was:
- face wash
- coffee beans
When I got home, I asked him whether he got the stuff I needed, and he said it was in the kitchen. I found the shopping bag sitting on the bench, I looked inside. And I found, face wash, moisturiser, coffee beans, shampoo and not one but two boxes of condoms. He must have thought all his birthdays and Christmases have come at the same time when he saw that on my list.
It is a good thing that most medical records are converted into electronic files, and doctors are no longer required to write, other than scribbling their signatures on printed reports, scripts and request forms. I was told once that the secret in writing doctor’s handwriting is to look at the first letter, and then the last letter. Look at the length of the line in between these two, and the brain should fill in the rest. To me, it’s a bit like deciphering an ECG (and for a surgeon, that is no small feat, as it is often the physicians who actually has the ability to read the subliminal messages in the wavy lines of an ECG). I would have a look at the squiggles, and see if at least one of the lines is recognisable. One can often decipher the overall meaning of an ECG (and a letter for that matter) once a something in the middle makes sense.
Even though now it is considered to be negligent if the writing in medical charts or communications is not decipherable, this has not stopped some hilarious misunderstandings due to bad hand-writing.
I was reviewing an inpatient with facial burns, whilst covering for a colleague. The patient asked me if he had to keep using the ointment my colleague prescribed him. I asked if he was getting a rash or reaction from the ointment. He said no, but he was getting bad diarrhoea and going to the toilet at least 4 times a day, usually after he has used the ointment. I looked at the notes to see what my colleague has written, and he wrote “Paraffin, top, prn” which basically means, vaseline topically to the burn wound, pro re nata (as required). I then looked at the medication chart, it was transcribed by the pharmacist into his medication chart as “Paraffin, 10g, PR” which means, 10g paraffin per rectum. Poor man was probably wondering why the nurses kept shovelling vaseline up his bottom when his burn is on the face.
Once, during a consultation, my patient handed me his referral letter from his doctor. He told me that he came to see me about his skin cancer. I nodded and read the short brief scribbled note.
“Dear Dr T, thank you for seeing this 46 year old man with a biopsy proven basal cell carcinoma over his right scrotal area.”
I stilled for a moment. Silently, I cursed my colleague, and wished he had sent this patient to a male surgeon. But I gave a mental shrug and got over it very quickly. I tried to make the patient feel comfortable by having a chat with him about his medical history, medications etc. Then I told him that if the cancer was small, I should be able to excise it under local anaeasthetic only, a bit like a vasectomy. I ignored his strange look. Finally, when I ran out of things to say, I asked if it was ok for me to call a chaperone so that I can examine him properly. He gave me another look, but shrugged ‘whatever you want, doc.’ I asked him to step behind the curtain, get undressed and lie on the bed. He looked distressed, then said, ‘but doc, I just need to roll up my sleeve, it’s here.’ He stuck his right wrist under my nose. Over his scaphoid area, was a small skin cancer. (For the non medics – scaphoid refers to the area at the back of the hand, near the base of the thumb.) Yep. I was walking a close line to being reported to the medical board for inappropriate sexual harrassment behaviour.
Once I received a letter from a doctor working in the country, who has been dressing my patient’s wound at home. Mrs M was a 50 year old lady who had very bad ulcers on her legs, and her doctor felt that they have deterioated, so sent her back to my office. I got her onto the bed, and opened the handwritten letter while my nurse was undressing her wound.
“…..I would be grateful for your input in her wound management, as I feel it is worse. The woman is pregnant, so I have tried to use some topical antibacterial dressings. If you feel that she requires oral antibiotics……..”
I looked up at Mrs M and frowned. ‘Is there something you would like to tell me?’ I asked her. She smiled sheepishly and admitted that she’s put on too much weight since she last saw me. I thought, well there are women who are having babies in their fifties, so I said ‘Congratulations, so how many weeks are you?’ Mrs M looked up with a start, then started laughing so hard she couldn’t get her words out, but I eventually worked out she was denying her pregnancy. I told her that’s what her doctor wrote. She insisted on reading the letter, after which, she started on another fit of laughter, with tears running down her face. My nurse snatched the letter out of Mrs M’s hands, and squinted her eyes as she read it several times. Then she pointed to the sentence ‘The woman is pregnant’ and said, ‘I think this says, the wound is pungent?’ Yep. The wound did stink out my office when the bandages came off. Mrs M needed to be readmitted to hospital, for antibiotics and dressing on the surgical ward. Not the maternity ward.
When I was working in general surgery, I once received a patient with questionable bowel obstruction transferred from another hospital. They were particularly concerned about him because he has not been able to tolerate any fluids orally. I was not convinced he had a true obstruction, but reluctantly accepted him despite the fact I was up for my second night on call in a row. He arrived through emergency with a hand written letter.
“….Mr XX has had ongoing retching for 24 hours, he last opened his bowels 3 days ago, and has farted since 6am this morning……”
I was livid. If Mr XX has passed wind, it meant he wasn’t really obstructed. He probably just needed to have a good enema. I couldn’t believe that I got woken up at 2am in the morning to see someone with constipation. I rang up the referring doctor and ripped through him (fuelled by lack of sleep) about unable to diagnose and treat constipation. When the poor man on the other end of the line got his chance to say something (because I stopped to take a breath), he said that Mr XX hasn’t passed wind for 3 days. I put on my self-righteous tone and referred to his letter. ‘No, no, no!’ the young doctor cried, ‘I wrote he has fasted since 6am’. Let’s just say, humble pie was not easy to eat at 2am after 48 hours of no sleep.
The best one arrived via fax. It was another handwritten referral letter I received from a local family doctor. Luckily, I was reading this before the patient came to her appointment. (Warning: I apologise in advance for the foul language you are about to encounter).
“Thank you for seeing Mrs Z, her cunt has been worrying her. she has tried many self-remedies to treat it she has applied several different herbal salves, soaked it in methylated spirits, pricked it with a needle, and tried to level it with sandpaper. She’s so fed up with it, she would like to see you about having it cut out…..
Ouch. Ouch. OUCH?!?!
Nah, I thought. I must have misread something. So I re-read the letter again and again. I scruitinised the offending word. But it was as if I was hypnotised, once the word ‘cunt’ was in my head, I couldn’t possibly see another word within that particular scribble. The harder I tried, the more blinded I was to any other possibilty. There was a curve like a ‘c’, and an end that is definitely a ‘t’. I took the letter to my secretary and asked her to read it. She started, ‘Dear Dr T, thank you for seeing Mrs Z, her…’ she stopped suddenly. Go on, I urged her. She looked at me with pleading eyes and told me she couldn’t bring herself to say the word. I gave it to my nurse, she raised her eyebrows at me. I thought about ringing the doctor and get him to send her to a gynaecologist. But my curiosity got the better of me. When she came into my room, I asked her to show me her problem. She smiled, bent over in her seat, and took her shoe off.
Under her big toe, was a plantar wart.
I have to admit, I have always struggled with hand-written letters from my colleagus, and I hang my head in shame on behalf of my profession. But personally, I have a valid excuse. After all, English is my second language and I failed spelling when I was in primary school, so I am pretty much illiterate when it comes to reading letters anyway.