HEALTHWATCH
Do not doctor yourself
ARUNA CHANDARAJU
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Are you the type to pop a pill for fever or headache? Beware the dangers of self-medication.
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PHOTO: BIJOY GHOSH
Alarming trend: See a doctor first.
BLAME it on those doctors who overcharge, over-prescribe, and order excessive diagnostic tests. Or hospitals, especially government ones, where one waits ages for an appointment. Or the explosion of medical info — reliable or otherwise — on the Internet. Or, the folly of people who feel experience has taught them enough to doctor oneself or others. And,our lack of an organised medical-care system.
Whatever the reasons, the alarming trend of self-medication is increasing, say doctors. Especially for colds, coughs, headaches, digestive problems, muscle aches, small wounds, anxiety, insomnia, weakness/debility.
Alternative to the doctor
Many people consider self-treatment with over-the-counter (OTC) medicines a hassle-free, cost-and-time saving alternative to visiting the doctor. And any temporary relief they find only reinforces this habit.
According to doctors, the most common self-medicated drugs are analgesics (pain relievers), anti-inflammatory drugs, fever-tablets, cough remedies, antacids, laxatives, antibiotics, tranquillisers/sleeping pills, vitamin and calcium supplements.
A related trend is to take doctor-advised drugs, but discontinue the course before prescribed duration since the person starts feeling well, and believes the doctor is overdoing the dose. While taking painkillers in an emergency is pardonable, and some self-treatment might have worked, overall, the hazards of self-medication are great.
"It's true, some doctors overcharge, make you wait long, and over prescribe medicines and tests," says Dr. Amar Chaturvedi, Mumbai-based physician, "but don't generalise, and don't lose out on honest doctor advice, which is indispensable."
One grave danger: self-medication often gives a temporary, superficial relief and thus masks symptoms, possibly indicative of a more serious problem. Simple fever drugs might be taken when that fever's actually indicative of malaria; headaches signalling brain problems may be treated with OTC headache medicines. All preventing timely, even lifesaving treatment.
Moreover, only doctors can tell you the duration, possible side effects and food, drinks and other medicines to avoid while taking one medicine.
Dr. Chaturvedi regrets that many people, upon onset of fever and body ache, begin taking a combination of anti-inflammatory, anti-fever tablets and antibiotics.
The first hazard: certain drug combinations could have deadly inter-effects.
Second, some might actually be ineffective. If a virus, parasite or microorganism causes the illness, an antibiotic that acts only on bacteria, will have no effect.
"Worse, if the person does later visit a doctor and is recommended a culture test to identify the infectious agent, the antibiotics ingested will prevent the culture from growing and thus hamper diagnosis."
Antibiotics and certain medicines can have dangerous side effects when taken without need and/or because of the person's peculiar constitution resulting in allergic reactions, rashes, indigestion, even damage to kidneys, heart and bone marrow.
Misusing the Net
Doctors say the Internet is a wonderful resource, one that they too use. However, some laypersons use its medical info indiscriminately for self-medication or to make wrong decisions about one's illness, feels Dr. Randeep Guleria, Professor of Medicine, AIIMS.
"Even the Net's qualified medical advice might suffer improper editing and thus mislead. Or be inadequate, treatment options other than those mentioned exist. And even if good, the user might not be equipped to understand it. Since many diseases have similar symptoms, he might mistake one problem for another. And since one illness has many types, some mistake a mild form for the severe one and become anxiety-ridden."
Finally, most Internet information does not, and cannot, take into consideration regional variations.
And a good prescription is one that considers local conditions, yours and your family history, which only a doctor can provide, adds Dr. Guleria.
Then there are self-appointed medics — the been-there-done-that type— who feel they are qualified to advise others in whom they see similar symptoms. Many diseases, given their deceptive manifestation, are difficult to detect even for doctors.
Another risk: the appropriate dose for one might be a harmful overdose for another.
Some chemists who sell scheduled drugs without prescription since they want to boost sales and the drug companies who look the other way, given that this is a market-driven economy, reinforce this trend, reveals Dr. Sanjeev Jain, psychiatrist, NIMHANS, Bangalore.
Self-medication with minor tranquillisers and sleeping pills is a significant trend, and as a psychiatrist he is especially concerned since "all the drugs we use in our psychiatric practice are scheduled drugs, none OTC. And sedatives/tranquillisers not taken under medical supervision easily lead to regular use, dependency and even severe addiction."
Stopping the medicines
The allied tendency frustrating many a doctor is discontinuation of the prescribed course once the patient starts feeling better. However, the rest of the course is absolutely vital since the medication must reach a certain threshold in the blood before all the harmful agents are totally destroyed.
By stopping the dose, the disease remains in the body, dormant for a while, and attacks again. And this time round, it may be a drug-resistant form or an allied one.
In effect, by shortening your cure, you make yourself vulnerable, even incurable.
"Under medication means a higher chance of relapse and even developing a drug-resistant disease," says Dr. Guleria. "The doctor could be treating you for residual disease and this is especially vital in problems like typhoid fever, TB, malaria and other infections like respiratory-tract infections."
Second, for non-infective disorders like asthma, sometimes, patients are asked to take inhalers for a longer period of time as a preventive measure. The patient may misinterpret this as overmedication, adds Guleria.
In psychiatry, Dr Jain says relapses happen more often due to intermittent medication.
Vitamin tablets, calcium and iron supplements are considered harmless for self-medication. However, ingesting amounts over the medically recommended daily allowance can interfere with the body's chemistry.
So, what are the solutions? Any information gathered from the Net or other patients must be discussed with the doctor. If you feel your doctor is over prescribing ask him for the reasons. If still dissatisfied, seek a second opinion than discontinue medicines.
Finally, what we need, says Dr Jain, is an easily accessible, supervised medical-care system so everyone can approach doctors with ease and confidence.
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