Chronic Diseases and the Risks of Self-Medication

The government has spent a lot of money on promotion and maintenance of healthy life style for her population. Health strategists went to the extent of having an annual disease-theme country-wide campaigns on such conditions as heart diseases and diabetes. Regular media advertisements, publication of booklets and brochures costing hundreds of thousand of dollars are main approaches to get to the masses, teaching and guiding them on how to achieve good health and avoid early development of chronic so called lifestyle diseases.

I think to a certain extent the massive health campaign has been successful in educating people on the need for proper nutrition and exercises.The emphasis is however on prevention and it so comes as no surprise that those who develop such chronic diseases are left to fend for themselves to manage their condition. Whilst many come to the clinic to get screened, diagnosed and managed on a lifelong basis, others especially those without any symptoms will carry on regardless till it is too late.

Some people will talk to their friends and compare signs and symptoms and self-medicate. Some will go to the private doctor and get diagnosed and prescribed anti-hypertensive or anti-diabetic whichever is the disease. As the cost of the drugs is quite expensive especially when one is supposed to  take them every day, the patient has the tendency to be non-compliant. He/she would go to the clinic whenever he/she feels like it. For some working with the private sector, their employer would pay for the cost of the drugs but once they leave their job they would find the cost  exorbitant. Being treated by the private sector is costly as well as once you are on a long term drug you need to have your blood monitored regularly for any adverse effects on your excretory organs such as the liver and the kidneys. The laboratory tests are indeed expensive. And so these patients will tend to self-medicate.

Despite the existing drug  legislations in this country, you can get most drugs from the pharmacies without a doctor's prescription. Yes, the truth is stranger than fiction.

I come across three classic examples of self-medication. The first one is a man of 73, FK who has been taking anti-diabetic drug for the last seven years without any doctor's prescription let alone monitoring. The other one is also a man, YW aged 62 who has been taking an anti hypertensive drug for one year on his own and the third is SS a lady of 53 who has been on the same dose of an anti diabetic drug for the last five years on her own after defaulting from a private doctor's follow-up. Sometimes she takes and other times she doesn't.

FK has been having recurrent itchy skin rashes and has spent hundreds of dollars at the private skin clinic to no avail.YW came with jaundice (yellowing of skin and eyes) and some smart non-pacticing doctor told him that he had a high blood pressure and that he should take medication so he takes the same medication as his wife who I prescribed a beta blocker a year ago but was lost to my follow-up as she decided to buy the drug herself! Normally this class of anti hypertensive is not prescribed to a man! SS was on the same antidiabetic medication for a long time without being monitored. Her sugar level must have gone "yo yo" as she did not take it on a regular basis.

As expected all these three patients have deranged liver and kidney tests and their conditions are not clinically controlled. FK's skin rashes subsided once his sugar level was normalized. SS's abnormal thirst and heavy and frequent  urination, signs of uncontrolled blood sugar, also subsided the same way once the correct dose of the drug was prescribed. YW who incidentally admitted taking some herbs ("misai kucing") as well,  was observed to have high blood pressure despite his self-medication. His jaundice is a cause for concern as his blood test done a year back before he defaulted treatment had already showed evidence of liver disease. Chronic jaundice has many undesirable implications and needs to be thoroughly investigated. I proceeded to appeal to the three patients to understand that they needed regular monitoring and that the doctors are here for them.

But just how many people out there are self-medicating for their chronic diseases  without knowing the risks? Their ability to purchase scheduled drugs from errant pharmacies ( and maybe even from online agents)  is frightening. It is no wonder that there is a rising trend of cases of chronic kidney failure in Malaysia. With the advent  of  drugs such as  Angiotensin converting enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) whose prolonged use to treat high blood pressure, could affect the kidney function of some patients, it is imperative that these patients be properly monitored.

In medicine, you need to manage a patient like you would your loved ones. That is a real job-satisfaction.