Doctors’ Deadly Scribbles: How poor handwriting in prescriptions jeopardizes patients’ Safety

By Oluwatoyin Hawal Momolosho and Ibrahim Arafat

In hospitals around the globe, prescriptions are handed out like roadmaps to healing, but to most patients, they read more like secret codes. The ink sprawls in cryptic loops and curls, forcing pharmacists into daily games of guesswork and assumptions. Watching from the sidelines, patients can only hope that the message gets through correctly.

For years, people have brushed it off, saying, “That’s just how doctors write.” But for many Nigerians, that “harmless habit” has become a serious risk. Health experts and pharmacists now warn that unreadable prescriptions are not just an inconvenience; they are leading to dangerous medication mistakes and, in some heartbreaking cases, preventable deaths.

Mr. Mekzy Emeka Zobo, who owns a pharmacy store in Nigeria, complained on his X account (formerly known as Twitter) about how some doctors write drug prescriptions for their patients. He explained that doctors send patients to the pharmacy to get medications, yet they scribble their handwriting so badly that pharmacists can’t understand it. These doctors already know that no pharmacist will grant such prescriptions, and patients end up blaming the pharmacists, thinking they are incompetent, without realizing the problem came from the doctor.

“Some doctors piss me off so much. You’re sending a patient to the pharmacy to get prescription medications, and you’re scribbling on a plain piece of paper,” Mekzy said.

“You know very well that no pharmacist will attend to that prescription. Now the patient is looking at me like the devil because I refused to acknowledge it. Because I am tired of the unclear handwriting. Despite several complaints but nothing changed. They saw it as what distinguishes their profession from others.”

“In the past, I used to tell the patients that the medication was out of stock, but I have stopped doing that. I just explained that it is not a valid prescription and told them that the doctor did it intentionally, so they have to go back to him,” he concluded.

Before now, it used to be said that doctors’ handwriting was naturally poor because of their profession. A report recently revealed that the Indian court had ordered doctors to change their handwriting when writing drug prescriptions or face consequences.

Justice Puri, one of India’s renowned judges, while reviewing a client’s medical report related to a rape case, was shocked when he couldn’t read the report written by a government doctor who examined the woman.

“It shook the conscience of this court, as not even a word or a letter was legible,” he wrote in the file issued to the doctor.

“At a time when technology and computers are easily accessible, it is shocking that government doctors are still writing prescriptions by hand, which cannot be read by anybody except perhaps some chemists,” Justice Puri added.

He urged the government to include handwriting lessons in medical school curricula and set a two-year timeline for implementing digitised prescriptions.

“Until that happens, all doctors must write prescriptions clearly in capital letters,” Justice Puri said.

Medical Association Response to the Court’s Claim

Dr. Dilip Bhanushali, president of the Indian Medical Association, which has more than 330,000 members, told the BBC News that they are willing to help find a solution to the problem.

He explained that in cities and larger towns, doctors have already moved to digital prescriptions, but in rural and small towns, it is still difficult to get clear prescriptions.

“It’s a well-known fact that many doctors have poor handwriting, but that’s because most medical practitioners are very busy, especially in overcrowded government hospitals,” he said.

“We have recommended to our members to follow the government guidelines and write prescriptions in bold letters that should be readable to both patients and chemists. A doctor who sees seven patients a day can do it, but if you see 70 patients a day, you can’t do it,” he added.

Chilukuri Paramathama, who runs a pharmacy in Nalgonda city in the southern Indian state of Telangana, told the BBC that in 2014, he filed a public-interest petition in the high court in Hyderabad after reading news reports about a three-year-old who died in Noida city after being administered a wrong injection for fever.

His campaign, which sought a complete ban on handwritten prescriptions, was successful. In 2016, the Medical Council of India ordered that “every physician should prescribe drugs with generic names legibly and preferably in capital letters.”

Statistics Behind Negligence

According to a 2017 report by Tandfonline media, doctors read prescriptions best, with a median correct percentage of 87.8%, compared with 81.8% for nurses and 75% for pharmacists. Mistakes occurred across all the specific items checked on the prescriptions.

Overall, errors occurred in 18.5% of prescriptions, showing that healthcare workers could read about 82% without mistakes. The most common errors involved the name of the medication, dosage, and dosage interval, as some workers omitted to read the duration and route of administration, even though these details were included.

The scale of the problem in Nigeria is alarming.

A nationwide study involving 2,386 health professionals, including doctors, pharmacists, and nurses, revealed that nearly half (about 47%) admitted to making medication errors during their careers. More than half of those errors occurred during the prescription stage, where illegible handwriting and incomplete drug information were the leading causes.

In another study conducted among hospital pharmacists in Lagos, 53.4% of all medication errors were traced to doctors’ prescriptions. These included wrong drug names, missing dosages, unclear instructions, and handwriting that could not be read.

Similarly, research published in the Ibom Medical Journal examined 941 patient case folders from a tertiary hospital in southern Nigeria and found that eight out of every nine prescriptions. About 89% contained at least one form of error, ranging from missing patient details to illegible writing.

These figures suggest that nearly every Nigerian patient has, at one point or another, received a prescription that could have easily led to the wrong medication being dispensed.

Globally, the World Health Organization (WHO) estimates that over three million people die every year as a result of medication errors, many of which stem from misread prescriptions or poor communication between doctors and pharmacists.

Yet despite this alarming data, Nigeria continues to rely heavily on handwritten prescriptions, with little oversight or digital reform.

Handwritten Prescription Regulations 

In Nigeria, the Poisons and Pharmacy Act (Cap 366, Laws of the Federation of Nigeria, 1990) and the Pharmacists Council of Nigeria (PCN) Regulations emphasized that every prescription must be legibly written, dated, and signed by a registered medical practitioner. The prescription must also include the patient’s name, age, address, and full details of the drug prescribed (name, dosage form, strength, and duration of treatment).

In the United States, the Controlled Substances Act (21 U.S.C. 829) and the Food and Drug Administration (FDA) Prescription Drug Marketing Act (1987) stipulate that all prescriptions, especially for controlled drugs, must be written clearly in ink, dated, and signed by the prescriber. These laws ensure accountability and help prevent drug misuse.

Also, in the United Kingdom, under the Human Medicines Regulations (2012) and the Misuse of Drugs Regulations (2001), handwritten prescriptions must be indelible, signed, dated, and contain prescriber identification. Illegible or incomplete prescriptions are considered invalid.

The Medical and Dental Council of Nigeria Code of Media Ethnics (2020) explained that the MDCN warned that illegible prescriptions can constitute professional misconduct, as they endanger patient safety.

The World Health Organization (WHO) provided global standards on safe prescribing. In its publication Guide to Good Prescribing (WHO/DAP/94.11), the WHO states:

“A prescription should be legible, dated, signed, and contain all necessary information on the medicine, dosage, and instructions for use.”

Experts Weigh in 

When A Nigerian pharmacist, Genesis Inarumen, says the time has come for Nigeria to adopt smarter, safer drug practices—driven by digital solutions and policy action.

“Drug safety isn’t just a clinical issue—it’s a national health emergency,” Inarumen said in an exclusive interview. “When patients receive the wrong drug or incorrect dosage, it’s not a minor error. It can mean the difference between life and death.”

The pharmacist, who has worked across both hospital and industrial settings—including the University of Benin Teaching Hospital and Biofem Pharmaceuticals—warned that medication errors remain one of the most preventable yet under-addressed issues in Nigerian hospitals.

Inarumen noted that medication errors in Nigeria stem from a mix of factors: illegible handwritten prescriptions, poor inventory control, inadequate pharmacist staffing, and limited access to patient histories.

“We still rely heavily on paper-based systems that are prone to human error,” he said. “You see prescriptions written in a rush, drugs dispensed without proper checks, and no reliable tracking of patient allergies or previous medications.”

Despite the promise of technology, Inarumen noted that regulatory frameworks and government support remain lacking.

“We need the Pharmacists Council of Nigeria (PCN), NAFDAC, and the Federal Ministry of Health to take the lead in setting digital health standards and encouraging investment,” he said. “Hospitals and private facilities won’t move unless there’s a clear policy direction and financial incentive.”

Also, Pharmacist Mubarak Bankole emphasized that there are established laws and professional standards guiding the presentation of medical prescriptions. According to him, every prescription must meet certain criteria to be considered valid, and one of the most critical features is legibility. “A prescription should be clear enough for anyone, including the patient, to read and understand,” he explained. Bankole noted that the legibility requirement is not just a formality but a legal and ethical obligation designed to prevent errors that could endanger patients’ lives.

However, he pointed out that poor handwriting among doctors has become a persistent issue, often attributed to heavy workloads and time pressure in hospitals. Doctors, he said, are expected to attend to numerous patients daily, which sometimes results in rushed and unclear handwriting. “Over time, it has almost become a culture. Many young doctors imitate their seniors without understanding that prescription writing follows specific rules. They see it as a professional style rather than a professional standard,” he remarked. This imitation, according to Bankole, has led to a widespread disregard for proper prescription writing practices.

Bankole also criticized the perception that illegible handwriting is a sign of professionalism. He argued that true professionalism lies in adhering to the laws and standards of medical practice, not in maintaining traditions that compromise safety. “Some doctors believe that writing in a certain way makes them appear more professional. But that’s not professionalism. Professionalism means following the right procedures,” he stated. He added that unclear prescriptions have, in some cases, caused serious harm due to misinterpretation by pharmacists or other healthcare workers. Bankole concluded that if doctors cannot write legibly, it would be safer for them to adopt digital or typed prescriptions to reduce avoidable medical errors.

Public health experts said that the Poor handwriting of doctors was not in any way intentional. 

Tanimola Akande, a professor of Public Health at the University of Ilorin, said that most doctors had good handwriting before medical school, but the lengthy lectures of medical school are a turning point in their  

Taking lecture notes for an average of 8 hours a day in the early days of medical school usually marked the beginning of changes in the handwriting of doctors. It included taking notes during clinical rounds.

“I agree with the explanation. The heavy workload requires fast documenting of the history of the illness and other related things in addition to clinical findings and writing investigations and prescriptions,” he said. “This is done for every patient, and the number of patients seen by doctors daily is overwhelming. This is worsening with the shortage of doctors due to brain drain,” Dr. Akande stated

However, the high number of outpatients and inpatients seen daily by doctors is high in Nigeria. Meanwhile, in Nigeria, the use of electronic medical records (EMR) is limited.

“I’ve heard of situations where patients suffered harm because of a misread prescription, but I’ve not witnessed any,” said Dr. Michael Olarewaju, a consultant obstetrician and gynecologist, and the immediate past secretary of the Nigerian Medical Association, FCT chapter.

Dr. Olarewaju acknowledged that while medical schools include communication training as part of their curriculum, introducing handwriting as a formal course would be unnecessary. He noted that the focus should remain on clarity and professionalism in documentation rather than teaching penmanship.

According to him, the real solution lies in modernizing the prescription process. He expressed strong support for a nationwide policy mandating digital prescriptions within a defined timeframe, describing such a move as both bold and beneficial for improving patient safety and reducing prescription-related errors.

Illegible handwriting in drug prescriptions was a serious concern that significantly affected the quality and safety of healthcare delivery. According to Muhammad Kabir Musa, a PhD pharmacist, many handwritten prescriptions were difficult to interpret, which often led to errors or delays in treatment. He explained that, in Nigeria, few studies had examined the issue, making it an underresearched area. His team conducted a study that found 38% of handwritten prescriptions were illegible based on the World Health Organization’s (WHO) prescription guidelines. These findings highlighted the need for advocacy and further research to understand why prescribers wrote illegibly and how such practices impacted patient safety.

In his experience as a hospital pharmacist, Musa noted that professionals like pharmacists, nurses, and physicians sometimes struggled to interpret prescriptions due to unclear handwriting. Although communication between prescribers and pharmacists was often used to clarify such cases, busy environments or poor coordination sometimes led to mistakes. He emphasized that pharmacists never guessed when dispensing drugs, as patient safety was always the top priority. When a prescription was unclear, the correct procedure was to contact the prescriber for confirmation before giving any medication to the patient. This professional diligence ensured that patients received the correct drugs, dosages, and instructions.

“Illegible prescriptions remain a serious problem in healthcare today,” Musa stated. “They violate medical ethics and endanger patients because every healthcare professional has a duty to communicate clearly. Clear writing is part of safe medical practice. That is why many hospitals and clinics are now adopting electronic prescribing systems—to minimize these risks and improve coordination between doctors and pharmacists.”

Oluwatoyin Hawal Momolosho is a Nigerian freelance journalist and writer from Kwara State, passionate about investigative reporting, education, and social impact. His work focuses on governance, climate change, and youth development in Nigeria.

Ibrahim Arafat is a young Nigerian graduate from the prestigious Usmanu Danfodiyo University (UDUS), a passionate  journalist, writer, and advocate of public speaking