Today the day after I wrote about the ills of self medication I had a patient who in my experience practised the ultimate self medication.
She is a Diabetic patient for the last 5 years and according to her the blood sugars were always high what ever tablets she used. Her husband was my patient for the last one year and for him I had started Insulin injections as his blood sugars were not controlled with tablets.With Insulin his Sugar values rapidly came to normal levels and his quality of life also improved.Seeing the improvement in her husband this lady on her own started taking her husband's Insulin one month ago.She was coming to me as a patient for the first time.And today she came to me with perfect blood sugar levels.
She said she feels much better now and asked whether she can continue on Insulin? What could I say?
Monday, June 9, 2008
Sunday, June 8, 2008
Self Medication
More dangerous than self diagnosis is self medication.Many in India do it.
Recently one of my patient,a 60 year old woman was admitted for blurred vision and giddiness on standing up. She was on regular medications for high blood pressure and this time on admission her blood pressure was very low. She said she had severe headache from morning.She thought it was because of high blood pressure and so she took an additional dose of her blood pressure reducing medicine.This self medication resulted in blurred vision and giddiness due to low blood pressure.
Tendency to continue taking medicines that produced immediate relief is very common.Most of the pharmacies in India give refills for old prescription with out any question.
Pain Killers are usually abused like that.Excessive use can produce Kidney and Liver damage.
One of my patient was using one such drug everyday for 20 years and she finally landed up with chronic kidney failure. Oral Steroid tablets are very popular among asthmatics and is easily available and cheap.Continuous use of Steroids can result in thinning of bones,Diabetes,recurrent infections etc.
Why people continue this dangerous habit of self medication?Is it just ignorance?
Recently one of my patient,a 60 year old woman was admitted for blurred vision and giddiness on standing up. She was on regular medications for high blood pressure and this time on admission her blood pressure was very low. She said she had severe headache from morning.She thought it was because of high blood pressure and so she took an additional dose of her blood pressure reducing medicine.This self medication resulted in blurred vision and giddiness due to low blood pressure.
Tendency to continue taking medicines that produced immediate relief is very common.Most of the pharmacies in India give refills for old prescription with out any question.
Pain Killers are usually abused like that.Excessive use can produce Kidney and Liver damage.
One of my patient was using one such drug everyday for 20 years and she finally landed up with chronic kidney failure. Oral Steroid tablets are very popular among asthmatics and is easily available and cheap.Continuous use of Steroids can result in thinning of bones,Diabetes,recurrent infections etc.
Why people continue this dangerous habit of self medication?Is it just ignorance?
Friday, June 6, 2008
Self Diagnosis
The other day I had an interesting patient. She was very forthcoming about her symptoms.This is what she said
' From yesterday morning my Spondylosis began troubling me.It started at the base of the neck and then spread up to all nerves in my brain.From evening onwards it was my Sinusitis with unbearable pain around my eyes. Today morning I was better as I slept with out a pillow. But by afternoon because of my new glasses [ which I began using one month ago] I had dimness of vision and watering of eyes. As I felt bad I took a pain killer which produced 'Gas' in my stomach and I had to vomit.
Many patients describe their illness like that.They will have all the diagnosis ready.They are so sure of the reason for their illness that sometimes I feel why they had come to me.May be just to confirm the diagnosis? Or to show off their medical knowledge?
With such patients it is very difficult to get a true account of his/her symptoms.A patient should try to tell the doctor what symptoms he/she felt, the order of occurrence of symptoms[chronology],what triggered/aggravated and what relieved the symptoms etc.It is better not to tell what he/she think is the cause of the illness unless asked to by the doctor.Let the doctor reach his/her own conclusion.
If the patient already come with a diagnosis of his own,there is a strong tendency among doctors to come to the same conclusion which many a time may be incorrect.Especially it happens with less experienced doctors working in Emergency Department. Several times I had seen the diagnosis given by the patient written down in the case sheet from the emergency department overlooking glaring clinical evidence to the contrary.This sometimes result in delay in diagnosis and unnecessary medications.
Ideally the above described patient should have told me about her symptoms like this.
'Yesterday morning I felt pain on the lower part of back of neck which slowly spread up to my forehead.By evening that pain was less but I had severe pain around my eyes.Today morning i felt better,I don't know why.But by afternoon I had some dimness of vision and my eyes started watering along with headache.I took a painkiller but after some minutes I vomited'.
However smart you are, it is always better to leave to the doctor the job of finding the cause of your illness.
' From yesterday morning my Spondylosis began troubling me.It started at the base of the neck and then spread up to all nerves in my brain.From evening onwards it was my Sinusitis with unbearable pain around my eyes. Today morning I was better as I slept with out a pillow. But by afternoon because of my new glasses [ which I began using one month ago] I had dimness of vision and watering of eyes. As I felt bad I took a pain killer which produced 'Gas' in my stomach and I had to vomit.
Many patients describe their illness like that.They will have all the diagnosis ready.They are so sure of the reason for their illness that sometimes I feel why they had come to me.May be just to confirm the diagnosis? Or to show off their medical knowledge?
With such patients it is very difficult to get a true account of his/her symptoms.A patient should try to tell the doctor what symptoms he/she felt, the order of occurrence of symptoms[chronology],what triggered/aggravated and what relieved the symptoms etc.It is better not to tell what he/she think is the cause of the illness unless asked to by the doctor.Let the doctor reach his/her own conclusion.
If the patient already come with a diagnosis of his own,there is a strong tendency among doctors to come to the same conclusion which many a time may be incorrect.Especially it happens with less experienced doctors working in Emergency Department. Several times I had seen the diagnosis given by the patient written down in the case sheet from the emergency department overlooking glaring clinical evidence to the contrary.This sometimes result in delay in diagnosis and unnecessary medications.
Ideally the above described patient should have told me about her symptoms like this.
'Yesterday morning I felt pain on the lower part of back of neck which slowly spread up to my forehead.By evening that pain was less but I had severe pain around my eyes.Today morning i felt better,I don't know why.But by afternoon I had some dimness of vision and my eyes started watering along with headache.I took a painkiller but after some minutes I vomited'.
However smart you are, it is always better to leave to the doctor the job of finding the cause of your illness.
Thursday, June 5, 2008
Medical Tourism in India. A Boon or Curse?
India's annual earnings through Medical Tourism is all set to double to 8000 Crore Rupees [2000 million US dollars] by year 2012 according to a recent study. The main reasons the study claims why medical tourism would flourish in India include much more lower medical costs for various surgical procedures such as bone narrow transparent, coronary bye-pass surgery, knee transplant and liver transplant as compared to western countries and even many of the Asian countries. Very good medical infrastructure not only in large Metros but also in tertiary towns is another reason for medical tourists favouring India.Availability of highly qualified medical professionals and nurses gives them the confidence to do such major procedures here.
How will this affect Indian Health care system?As per World Bank estimates about 80% of all health spending in India is in the private sector.Most of the Posh private hospitals are out of reach of majority of Indians.They are considered as gleaming Islands of excellence surrounded by seas of medical neglect. So a doubling of medical tourism earnings may only make these Islands of excellence more and more inaccessible to common people.Also more and more of the qualified medical professionals may opt out of Govt run Hospitals for highly paid jobs in private sector.This will further weakens Public Health Care
If the Government [which now spends less than 1 percent of its GDP for health sector] can direct some part of the revenue the Health Industry will earn by medical tourism for strengthening the Public health care network the poor Indians may benefit.But that needs considerable amount of Political will and perseverance.
How will this affect Indian Health care system?As per World Bank estimates about 80% of all health spending in India is in the private sector.Most of the Posh private hospitals are out of reach of majority of Indians.They are considered as gleaming Islands of excellence surrounded by seas of medical neglect. So a doubling of medical tourism earnings may only make these Islands of excellence more and more inaccessible to common people.Also more and more of the qualified medical professionals may opt out of Govt run Hospitals for highly paid jobs in private sector.This will further weakens Public Health Care
If the Government [which now spends less than 1 percent of its GDP for health sector] can direct some part of the revenue the Health Industry will earn by medical tourism for strengthening the Public health care network the poor Indians may benefit.But that needs considerable amount of Political will and perseverance.
Wednesday, June 4, 2008
Stay away from this Temple feast
Visit to a Temple [or any other religious place] is always a great experience. It brings peace to our mind and washes away depression and sorrows. We get 'prasadam', which we eat with reverence and gratitude with the belief that it will make us better in body and mind.
When we see frequently devotees getting sick after pilgrimage to a particular Temple, our suspicions are raised. For last few years, I am seeing devotees getting sick within few days of their travel to Mookambika Temple at Kollur, Karnataka. Many had a severe form of typhoid, some had jaundice due to Viral Hepatitis, and most had an acute self-limiting diarrhoeal disease. Almost all my patient devotees had taken the Temple feast. I strongly suspect either there is fecal contamination of the water used for drinking /cooking, or one of the food handler may be a carrier for such disease causing organism. I had informed this to local Public health authorities, but it seems not much action had been taken as the Temple is in a different State. So now it is wiser to stay away from the temple feast there to maintain the health of our body. Or will the Temple authorities of one of the most famous Devi Temples of India wake up and act?
When we see frequently devotees getting sick after pilgrimage to a particular Temple, our suspicions are raised. For last few years, I am seeing devotees getting sick within few days of their travel to Mookambika Temple at Kollur, Karnataka. Many had a severe form of typhoid, some had jaundice due to Viral Hepatitis, and most had an acute self-limiting diarrhoeal disease. Almost all my patient devotees had taken the Temple feast. I strongly suspect either there is fecal contamination of the water used for drinking /cooking, or one of the food handler may be a carrier for such disease causing organism. I had informed this to local Public health authorities, but it seems not much action had been taken as the Temple is in a different State. So now it is wiser to stay away from the temple feast there to maintain the health of our body. Or will the Temple authorities of one of the most famous Devi Temples of India wake up and act?
Monday, June 2, 2008
Are we winning against Tuberculosis?
It is now 2008,more than 40 years after the discovery of Rifampicin, the most potent drug against Tuberculosis.The 3 or 4 drug cocktail that includes Rifampicin almost always work against Tuberculosis.These drugs are available free of cost at Government health units through out India.Still TB is rampant and some say it is increasing.It is estimated that about 1 in 3 of new TB infected patients do not get access to the Govt run TB control programme. Even if they get access it is not properly utilised.
Last week I started anti tuberculous medicines in 5 patients,3 of them on the same day. I offered them reference to Govt TB control facility.I told them that they will get the drugs free of cost and that the drugs are of good quality.But only one, a poorly paid nursing trainee took the offer.Others were not rich but were ready to spend money from their pocket for the medicines.Why?
Their confidence in approaching the Govt run TB control centre was low.One reason is such centres are notorious for lack of efficiency. Patients may have to go there several times before they get the medicines.Timings of such centres are such that the patient will have to sacrifice few of his/her working days.Also there is stigma associated with queuing up in front of the crowded TB centre.When drugs are available in private pharmacies at a reasonable cost [as there is a Govt control on prices] why should one take all the pains to get those medicines free?
Inefficiency,lack of privacy,unsuitable working hours,ignorance of the public etc are some of the reasons behind the lack of success of TB control programme even in a literate and health conscious,Semi-urban State of Kerala.So we can very well imagine the plight of the programme in other States of India.
Last week I started anti tuberculous medicines in 5 patients,3 of them on the same day. I offered them reference to Govt TB control facility.I told them that they will get the drugs free of cost and that the drugs are of good quality.But only one, a poorly paid nursing trainee took the offer.Others were not rich but were ready to spend money from their pocket for the medicines.Why?
Their confidence in approaching the Govt run TB control centre was low.One reason is such centres are notorious for lack of efficiency. Patients may have to go there several times before they get the medicines.Timings of such centres are such that the patient will have to sacrifice few of his/her working days.Also there is stigma associated with queuing up in front of the crowded TB centre.When drugs are available in private pharmacies at a reasonable cost [as there is a Govt control on prices] why should one take all the pains to get those medicines free?
Inefficiency,lack of privacy,unsuitable working hours,ignorance of the public etc are some of the reasons behind the lack of success of TB control programme even in a literate and health conscious,Semi-urban State of Kerala.So we can very well imagine the plight of the programme in other States of India.
Sunday, June 1, 2008
Fever time again
It is rainy season again,and for us doctors it is usually a busy time. Out Patient Clinics and Hospital wards fill up with patients having various kinds of fevers.
Being specialised in Internal Medicine I get lot of referrals of patients with undiagnosed fevers.It is a trying time as in many cases the initial examination and lab tests may not give you a definite diagnosis.And always the patient and /or his relatives want me to say a clear cut cause for the fever at first consultation itself or at least with in a day.
Many of the serology tests become positive only after a few days and the clinician have to depend up on his clinical judgement and experience to come to a possible diagnosis and start treating the patient. For this history of the illness is very important.Most often the patient do not realise it and is not very forthcoming when asked persistent questions about the chronology of the events. Information like whether the fever started as low grade or high grade,whether there was shivering of the whole body at the onset,what other symptoms accompanies the fever etc are very important in arriving at a diagnosis.In many cases the answers to the above questions determine the initial treatment as there may not be any other clue in physical examination.Finding out the correct cause of fever is almost like a detective work.Many clues may be there but some may mislead you to a wrong diagnosis. This challenge of Fever of Unknown origin is one of the most interesting aspect of the professional life of a doctor like me
Being specialised in Internal Medicine I get lot of referrals of patients with undiagnosed fevers.It is a trying time as in many cases the initial examination and lab tests may not give you a definite diagnosis.And always the patient and /or his relatives want me to say a clear cut cause for the fever at first consultation itself or at least with in a day.
Many of the serology tests become positive only after a few days and the clinician have to depend up on his clinical judgement and experience to come to a possible diagnosis and start treating the patient. For this history of the illness is very important.Most often the patient do not realise it and is not very forthcoming when asked persistent questions about the chronology of the events. Information like whether the fever started as low grade or high grade,whether there was shivering of the whole body at the onset,what other symptoms accompanies the fever etc are very important in arriving at a diagnosis.In many cases the answers to the above questions determine the initial treatment as there may not be any other clue in physical examination.Finding out the correct cause of fever is almost like a detective work.Many clues may be there but some may mislead you to a wrong diagnosis. This challenge of Fever of Unknown origin is one of the most interesting aspect of the professional life of a doctor like me
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