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PLAY IT SAFE Go by the doctor’s instruction

This could be a visual on a quiz show. An educated-looking man goes to a pharmacy, produces a sheet from a doctor’s pad and says, “The Rabisip & Motilium M tablets don’t seem to agree with my nephew. Can you give me a substitute?”

Question: What’s wrong with this? The medical shop owner (MSO) should not be asked this question.

But, MSO Nagappan says that “85 per cent of the customers consult me over the prescription. They trust my judgment.”

He gives you a list of FAQs: Should I take the medicines before or after meals? What is this tablet for? Dosage? Any side effects?” “Is it okay for my four-year-old?

“Both the educated and the uneducated ask these,” he says.

“I know most of them and their ailments, and haven’t had any problem so far,” he claims. When in doubt, he calls the doctor.

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, Chennai. For eye infections, they use the drops suggested by the MSO. Sometimes the condition flares up. Severe pain and corneal ulcer might lead to blindness. “The tragedy is, it is 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..”

Sure, but what happens when docs forget the Hippocratic oath, asks Shoba, a computer executive. “My mom followed 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?”

“Pharmacists, hospitals and clinics should display boards announcing, “Not qualified to prescribe” or “Medicines only against prescription,” suggests Dr. Rajan. “Some eye drops can be administered only under medical supervision. They should insist on patients reporting progress.”

Sadly doctors do prescribe what pharma firms ask them to, he admits.

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.

“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.” And, buy the medicine somewhere near the clinic. “That way, if the one prescribed is not available, it can be changed.”

GEETA PADMANABHAN

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