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Letter to the Editor

Editor, – Dr Nisselle's remarks on the legal significance of prescription writing are very much to the point (Aust Prescr 2004;27:108-9). I would like to take him up on the statement that 'prn' is an antiquated Latin abbreviation, when in the next column he uses an equally antiquated Latin term, 'mens rea', no less than three times. This term is one of a whole library of Latin terms used by the legal fraternity to befuddle the rest of the population. Why choose 'prn' when there are 'bd', 'tid', 'bid', 'ac', 'pc' and many other Latin abbreviations, some of which get more use than 'prn'. Used properly these abbreviations are very helpful in saving time and space.

In the 1950s there was an arrangement between Yugoslavia and the UK for reciprocal medical treatment of visitors. Inevitably, some British tourists fell sick and returned home with summaries of their treatment. These were written in Latin so I was able to translate the diagnosis and treatment. I would not have been capable of doing this if the summaries had been in one of the local languages.

I might add that I was not a Latin scholar, having as much trouble with 'ut' and the subjunctive as anyone. However, I think medicinal Latin was a very useful attribute and I do regret its loss.

L.A. Lees
General practitioner
Dapto, NSW

Author's comment

Dr P. Nisselle, the author of the article, comments:

Like Dr Lees, I have both nostalgic and practical reasons for personally wanting to retain Latin abbreviations in medicine. Nostalgic, because it reminds us of the history and traditions of medicine. Practical, because using shorthand saves a lot of time. But is it still safe? Dr Lees talks about being in practice in the 1950s. Many younger doctors and pharmacists have no knowledge of the abbreviations that were in common usage at that time. The lawyers have preserved Latin better than doctors. Phrases like 'mens rea' and 'res ipsa loquitur' are still in common use because they are still taught in law school. Latin remains alive in medicine, for example, in anatomy but even there, plain English is encroaching. Materia Medica is no longer taught. I doubt if any medical faculty in Australia still teaches Latin prescribing instructions in their pharmacology course.

In day-to-day office general practice, many general practitioners now use prescription writing software which is fast, efficient, safe and can be programmed to provide plain English, unambiguous instructions for taking each medication prescribed. Safety overcomes my nostalgia. If you know for certain to which pharmacist the patient will take your script, and if you know for certain that the particular pharmacist understands all the abbreviations you use, and if you know that every doctor who subsequently will use the record you generate of that consultation understands Latin abbreviations, then you might choose to save time and use Latin-based shorthand like 'prn'. For me, there are too many 'ifs' in that statement. Safe prescribing requires clear, unambiguous instructions.

Editor, – I am saddened by the misuse of the Latin abbreviations 'tds' and 'tid' which today are almost universally used for 'three times daily'. In Latin (and in common usage through my career) 'tds' (ter die sumendus) translates as 'to be taken three times a day' (sumendus = to take). Hence 'tds' should be used for oral medications. 'tid' (ter in die) translates as 'three times daily' and should be used for external medications.

Unfortunately, the distinction has been blurred over the years and both abbreviations are now treated as equivalents. If we are to continue to use Latin abbreviations in the directions, we should use the correct terminology. Perhaps this shift in meaning has occurred because Latin is a subject that has been dropped from most schools and, I presume, the curriculum for medical and pharmacy students.

Peter Castellaro
Clayfield, Qld

Australian Council for Safety and Quality Working Party comments

John Youngman, Chair, Australian Council for Safety and Quality Working Party, Standard Medication Chart, comments:

Medication errors are a significant cause of harm to patients. Standardisation of processes and their constituent components has been demonstrated to reduce medication errors. In April 2004 Australian health ministers agreed to support the introduction of the National Inpatient Medication Chart into public health facilities by mid-2006. The Australian Council for Safety and Quality in Health Care formed a working party to develop the chart which will be pilot tested in 30 public and private facilities. This national chart will build on the content and implementation of a standard chart used in Queensland public hospitals.

The National Inpatient Medication Chart is underpinned by a core set of principles and an agreed set of abbreviations, particularly focusing on the prescribing and administration of medicines in hospitals. Medication administration guidelines adopt 'mane' for morning, 'nocte' for night, 'bd' for twice a day, 'tds' for three times a day, 'qid' for four times a day, and for the administration of antibiotics '6 hrly' and '8 hrly'. Such standardisation will enable medical and nursing staff moving across facilities to use the same abbreviations and so reduce the likelihood of a misunderstanding or a mistake in the prescribing, dispensing and administration of medications to patients.