A few days ago I was speaking to a friend over phone. Her voice was quivering and I could make out that she was unwell. On further inquiry I gathered that she had chills, fever, pain in the back and joints. On hearing this I was naturally worried as these are some of the symptoms to Dengue. I recommended that she meet a doctor immediately. She was reluctant to go as she had already taken some fever medication. But I still insisted and she finally did visit a doctor. Luckily for her, she tested negative for Malaria and Dengue, but she still had infection and the doctor prescribed the necessary antibiotics.

The incident got me to think about the state of self-medication in the country. In 2015 an online portal had asked more than 20,000 respondents questions around medication. More than 50% respondents had resorted to self-medication that year. I am not surprised at the number. The most common reasons given by the respondents were the exorbitant fees at private clinics, long lines at government run hospitals and the reluctance of the patients to get diagnostic tests done.

I usually take Online surveys with a pinch of salt as most people do tend to lie on such surveys. According to a study conducted among 352 patients in Puducherry across 124 households it was found that Prevalence of self-medication was found to be 11.9%. Males over 40 years involved in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage . Fever (31%), headache (19%), and abdominal pain (16.7%) are most common illnesses where self-medication is being used. Telling the symptoms to pharmacist (38.1%) was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6%) and they are going to use (90%) and advice others also (73.8%) to use self-medication drugs.

I think the numbers are more realistic here but again regional variation could change all that. I would expect the numbers to be higher in the north and the east of the country and lower in south and west.

Another exploratory study conducted by Greenhalgh T studied the drugs supplied to 2400 patients by the public and private medical sectors and by private pharmacies. These were supplied based on patient complaints on illness and subsequent prescriptions from the doctors. The most interesting finding of the study was the private sector was prescribing more drugs than the government run hospitals. Many of these drugs were combination preparation (Medical Cocktails) and also contained some hidden classes of drugs.

Prescription medicine was being sold over the counter, some very powerful medicines were being prescribed for simple conditions. Also many drugs banned in the  west were still being prescribed in India. Another interesting finding was that food supplements and tonics of dubious nutritional and pharmacological value make up a high proportion of the total drugs bill.

The study also concluded that any drug policy from the government might have  to involve doctor and pharmacist education to reduce the over prescription of drugs.

There are many dangers of self medication. Apart from side effects and ill effects, most public health experts feel that it leads to long term challenges like

1. Drug resistance, this is the biggest challenge in our fight against TB for example. Ciprofloxacin prescribed for throat infections is also an anti-TB drug
2. Allergies, as most of these combination medicines with hidden classes of drugs are notorious for causing allergies
3. Late diagnosis – If self- medication is the first line of attack, often by the time the patient reaches the doctor is often late, late diagnosis leads to late treatment, delayed recovery and more medical bills.

So in my opinion 3 things you should do immediately

1. Stop self-medication immediately. Period. No need to explain that one.
2. Visit your doctor in case of any symptoms. If you don’t have a family doctor then, identify a good family medicine practitioner in your neighborhood and visit him regularly.
3. Maintain all your medical records, there are apps that can help you with in, otherwise just keep a file if you are not tech savvy. Scanning and uploading records to Google Drive is also a good option. But there are privacy concerns around it so be very careful with your records.

In conclusion, if you time to visit the mall or the hair dresser regularly then visiting the doctor should not be such a painful experience. In the end if you see it is our mindset that needs to change.

Sources

Prevalence of self-medication practices and its associated factors in Urban Puducherry, India Kalaiselvi Selvaraj, S. Ganesh Kumar, and Archana Ramalingam

Drug prescription and self-medication in India: an exploratory survey. Greenhalgh T.

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