Kerala Doctors' use of 'Repeat All' on prescriptions triggers controversy

Kottayam: The use of the shortcut phrase “Repeat All” by doctors on patient prescriptions, instead of writing down each medicine name specifically, has stirred controversy, with concerns emerging over the potential misuse of certain allopathic drugs. Shockingly, it has been found that doctors used this method even on five years old prescriptions.  

Government doctors often resort to writing “Repeat All” on prescriptions during hectic outpatient hours, using it as a time-saving measure. However, this practice is not particularly followed by everyone in the medical fraternity.

Doctors are naturally recommended to write the full names of medicines on prescriptions to avoid any confusion or errors at the pharmacy. The clear instruction in the prescriptions helps pharmacists from making any mistakes since any mistakes in this process could lead to a potential health risk for patients.  

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Questioning why doctors follow such practices, the Kerala Health Department has issued a directive to District Medical Officers (DMOs) to review and clarify their stance on the continued use of the term, following a formal complaint by the Kerala Government Pharmacists Association.

The association highlighted the issue through a letter to the health department. It pointed out the risks involved when doctors write "Repeat All" on prescriptions without specifying the names of the medicines.

In a letter to the Director of the Health Department, the association urged the department to ask doctors not to use such practices and to follow proper prescription practices. 

"Patients undergoing extreme care and those with lifestyle diseases, and those enrolled in the Community Mental Health Program are often prescribed the same medicines on a monthly basis. These patients are also provided with a booklet to record their medicines. During their monthly visits, doctors usually enquire about changes in the patient’s condition. If the answer is “no,” the doctor simply writes “Repeat All” referring to the earlier prescriptions. It is then up to the pharmacist to flip through the pages and identify the medicines to be given," reads the letter. 

The association made a shocking revelation that even prescriptions written five years ago are being repeated in this manner. The issue traces back to the COVID-19 pandemic, when many patients began collecting their regular medications directly from pharmacies without consulting a doctor or obtaining fresh prescriptions. While this was tolerated during the crisis for continuity of care, the Kerala Government Pharmacists Association claims the practice has persisted in several hospitals even after the pandemic ended. 

Dr MC Tomichen, retired RMO of Kottayam Medical College, told Mathrubhumi that the correct procedure is to write the prescription clearly each and every time. He feels that prescriptions marked with “Repeat All” are vulnerable to misuse. He also said that pharmacists should remain vigilant when handling such notes.

Last month, the District Prescription Audit Committee in Pathanamthitta issued a directive to doctors urging them to avoid using 'Repeat All' on prescriptions to prevent the risk of giving incorrect medicines to patients 

Commenting on the matter, Dr KA Sreevivas, State President of the Indian Medical Association (IMA), also insists that the full name of each medicine should be written clearly on the prescription. This helps pharmacists avoid errors or confusion when giving medicines. He acknowledges that some doctors may write “Repeat All” due to time constraints, but that not all doctors follow this shortcut.

Also read- 50 percent medical prescriptions issued in India deviate from standard guidelines, 10 percent have unacceptable deviations: AIIMS Study