The hidden costs of poor handwriting on our health service

by | Apr 13, 2023 | Uncategorised | 0 comments

It may be something that sounds trivial, but poor handwriting has been a significant problem, and cost, for the UK healthcare system for many years.

In past centuries, doctors would keep handwritten notes as a personal record of the patient’s medical history. And these were generally only seen and used by the doctor. However today doctors and clinicians work in cross disciplinary teams, across 1000’s of patients, often with dozens of other professionals. In healthcare teams that collaborate and share notes, records and resources. 

A consequence of this is that any illegible scrawls, hurriedly composed by overworked clinicians, are now presented to colleagues for interpretation. Professionals, often of different nationalities, can spend significant time and effort trying to decipher notes about dosages, symptoms, medication or to confirm a signature is present and legible. This is particularly prevalent when dealing with sound-alike look-alike drugs (SALADs)

The considerable time and frustration associated with this detective work takes valuable resources away from other important caregiving tasks. It’s an unfortunate truth that poor handwriting contributes to the high incidence of medical errors in Britain, which is estimated to cause the deaths of over 22,000 people at a cost of £1.6bn each year

While many healthcare providers have moved towards electronic records and prescription systems, the issue of illegible handwriting persists. There have been many well publicised issues and legal cases including misdiagnoses, medication errors, delays in treatment and fatalities that have all stemmed from issues with handwriting. 

In 2005, three surgeons audited the legibility of 40 randomly selected operative notes from an orthopaedic ward in a large British hospital. Two nurses, two physiotherapists and two medical house officers were asked to rate the legibility of the notes as ‘excellent’, ‘good’, ‘fair’, or ‘poor’. Only 24% were rated ‘excellent’ or ‘good’, and 37% were deemed ‘poor’. A more recent and rigorous study in 2021 showed that 43% of medication errors in intensive care units were caused by illegible handwriting.  

There are contractual duties of care standards for handwriting, and poor record keeping by health care professionals can result in legal action being taken against them. If records are brought before a court of law the use of correction fluid, deletions and sloppy handwriting can be interpreted by the judge and jury as sloppy care and create a damaging impression.

Additionally criminalising these mistakes is controversial, and can encourage a blame culture rather than one of accountability. Undoubtedly adding further pressure and responsibility to increasingly overworked clinicians. The byproduct of which is that clinicians and nurses in particular are leaving the profession in record numbers.

In my experience, illegible handwriting will most often delay treatment (particularly dangerous in emergency situations), and in rarer cases leading to unnecessary tests and incorrect doses. The worrying thing is that even with the partial digitisation of some processes, some hospitals are seeing an increase in errors

It’s clear that the cost, both financial and human, of poor handwriting in the UK health service are significant. So how best to fix this problem? Handwriting tests and penmanship classes are archaic and electronic prescribing is the obvious solution here (which we have seen in quantity), but what about other paper notes that are important for patient safety other than prescriptions? 

Paper handover sheets as a word/excel document or scrap paper lists still scatter our NHS wards. From my experience, I was unable even to interpret my own handwriting hours into my shift, often forgetting what task was initially needed leading to anxiety and fear that I may have forgotten something. From doing extensive stakeholder engagement, other nurses/doctors have experienced the same problems sharing their experiences of “crowded paper lists” and carrying “multiple lists in their scrub back pocket” in an attempt to manage the information overload.

Whilst we don’t think there’s a silver bullet that will solve all of the challenges outlined above. It’s my opinion that the increased workloads of medical staff and the backlogs caused by COVID certainly haven’t helped. I witness each shift the cognitive burden and sheer volume of information and tasks expected of front line workers, it is unmanageable, dangerous and needs to change. 

Reducing this cognitive load and the stress, strain and responsibility placed on front line workers is something that has been a driving consideration for why we started Lister. We understand clinical settings, the complexities of the healthcare system and the problems that exist here. We believe our app can go some way to reducing these costs – improving safety, reducing human error and improving the conditions for healthcare workers. 

If you would like to hear more or to share your experiences, then please reach out to me at