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PLAY IT SAFE Go by the doctor’s instruction

Question: what’s wrong with this? That’s right. The medical shop owner (MSO) should not be asked this question. But listen to what Nagappan, MSO for five years says. “85 per cent of the customers consult me over the prescription. They trust my judgment.” He gives you a list of FAQs: “When should I take the medicines, before or after meals? How should I take it? What is this tablet for? What is the dosage? Any side effects?” And the absolutely scary, “Is it ok for my 4-year-old?” “Both the educated and the uneducated, the elderly and those who can’t read ask these,” said Nagappan. “I know most of them and their ailments (!)” He hasn’t had any problem so far, he claims. He calls the doc if he has a doubt.

Call it the Rx syndrome. Or low health literacy. Symptoms include inability to decipher prescriptions and/or follow instructions. Carelessness in taking medicines. Forgetfulness in going for a follow-up. In acute cases, asking for the MSO’s advice or using an old prescription. Result: undertreatment and doc’s bafflement: Are patients not responding to the medication or they are not using the medication?

“We get one case a day of a patient with an aggravated problem,” said Dr. Mohan Rajan of Rajan Eye Clinic. “Patient notices a red eye in the mirror, concludes it’s Madras eye and decides to do something about it. Good. Only he wants to do it himself. This is how it goes.

Home remedy pharmacy eye drops suggested by MSO eye infection masked. Infection flares up. Severe pain and corneal ulcer might lead to blindness. “The tragedy is, it’s so preventable.”

For eye problems, go to an ophthalmologist, optometrists cannot prescribe in India, Dr. Rajan warns. “Do not go to the pharmacy without a proper prescription. Don’t take antibiotics on your own – it could be fungal or viral infection. There are several reasons for eye redness.”

Sure, but what happens when docs forget the Hippocratic oath, asked Subha, a computer exec. “My mom did follow her regimen for BP and sugar and ended up at a gastroenterologist’s. The next doctor helpfully said one of the drugs might make mom feel giddy, but she would get used to it soon. He did not volunteer this info. What if she had had an attack of giddiness in the bathroom? In the unkindest remedy of all, one medico prescribed an antibiotic that cost Rs. 40 per tablet. Mom complained. The good doctor offered to get it for Rs. 35. Very fishy!”

“But doctors are forced to give irrational prescriptions,” said a scientist at the Tuberculosis Research Centre, “for psychological satisfaction. Cold/cough/fever takes at least a week to get better. The patient feels disappointed if he is told that. Antibiotics are prescribed, while a painkiller would do the job. Most rural patients insist on injections, or they threaten to complain to officials.” Unnecessary medication leads to drug resistance and acidity/ stomach upset. Often, patients go directly to the pharmacist.

“Pharmacists, hospitals and clinics should display boards announcing, “Not qualified to prescribe” or “Medicines only against prescription,” suggests Dr. Rajan. “Doctors should educate patients on the effects of the medicines they prescribe. Some eye drops can be administered only under medical supervision. They should insist on patients reporting progress. Patients can call, send e-mail and come back for consultation when the dosage gets done.”

Sadly doctors do prescribe what pharma firms ask them to, he admits. But the efficacy of the same medicine from different companies is not uniform. Also, normal antibiotics may not work over a period of time. It is best the doctors explain procedures patiently and record them on the case sheet. Can pharmas simplify names of drugs once they become generic?

“Prescriptions should be legible and in full form,” says Dr. Rajan. “Shouldn’t look like an ECG graph. They should carry the strength (10, 25 mg) clearly. How many, when, dosage, before – after, duration and follow-up date.” He would like us to buy the preparations somewhere near the clinic. “If the medicine is not available, we’ll change it.”

The danger-ridden reality is that doctors are time-challenged. “I was stunned by a cardio’s response to my questions on my father’s treatment,” says Radhika Sriram. “He asked, ‘Are you testing my knowledge?’” Lakshmi made the mistake of checking out the drugs. “You ask intelligent questions and this is what you get: “You think you know more than I do?””

What did Nagappan do? “We do substitute when there’s no stock,” he admits. “The brand, not the medicine. This is a cut-throat business.” Well, in more ways than one.

In a memorable track, comedian Vivek writes a prescription and asks the patient to “take it”. The patient crunches the paper and swallows it carefully. Better than swallowing wrong medicines, any day.

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