Compulsory columns in a medical prescription

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A prescription is an integral part of a consultation as it summarizes the instructions of the doctor to the patient. The Free Dictionary has defined a prescription as “a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient” (http://medical-dictionary.thefreedictionary.com/prescription). Handing over of the prescription by the doctor to the patient marks the conclusion of every consultation, be it a new consultation or a follow up visit.

A medical prescription traditionally enumerates the drugs that have been prescribed, along with directions for the patient to follow when taking the drug and the diagnosis. Some significant clinical findings may also be mentioned.

There are four parts of a typical prescription

• Superscription: Indicated by the sign Rx meaning recipe, take
• Inscription: This is the main part of the prescription, contains the names, doses and dosage forms of drugs ordered.
• Subscription: Directions for compounding of drugs
• Signature: Instructs the patient about how to take the drugs prescribed and is preceded by the symbol S or Sig (signature – Latin)

Noncommunicable diseases (NCDs) such as heart disease, stroke, cancer, diabetes and chronic lung disease are a major public health problem now incurring significant costs in their management. The Global Status Report on Noncommunicable Diseases 2010 by the WHO states that “NCDs are caused, to a large extent, by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization and 21st-century lifestyles: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol”.

Given the alarmingly high prevalence of lifestyle diseases worldwide, including India, it’s now time to move beyond the confines of the traditional way of writing a prescription. In addition to the demographic data and drugs, a prescription should have some ‘compulsory columns’.

• Hygiene
• Vaccines
• Addictions
• Noise pollution
• Standard Lifestyle
• Rehabilitation: Exercise, job, vacation
• Counselling: Diet, mental health, exercise
• Point of Care Investigations: ECG, blood sugar, pocket spirometry, urine spot test, hemoglobin, blood counts, coagulation etc.
• Noise pollution check
• Air pollution check: PM 2.5, PM 10
• Important phone numbers: Police, hospitals, ambulance, fire department, emergency
number (Similar to 911 in US, the single national emergency number in India is 112)

Adding these components to a prescription is an intervention towards ‘preventive healthcare’, primary prevention or secondary prevention and check the rising prevalence of chronic lifestyle diseases. This way doctors can motivate their patients and support them to make healthier lifestyle choices.

Dr KK Aggarwal
National President IMA & HCFI