Juggling Jobs and Overworked Doctors
ByTiana Mendis-2018-01-31In their over enthusiasm to prescribe medication and sometimes overload patients with unnecessary drugs, doctors the world over have been accused of having unholy partnerships with pharmaceutical companies - an accusation which is vehemently denied by both parties. A couple of years ago, the Government and the Health Ministry tried to take measures to prevent medical practitioners from prescribing drugs with brand names. In fact there is this practice of prescribing generic names even in advanced countries like the UK; so why not Sri Lanka
However, the pharmaceutical companies came out fighting tooth and nail and doctors too joined in, saying that if they were to assure the healing of their patients, they needed to have confidence in the drugs they prescribed and therefore the necessity of the brand name.
Transparency
This writer is not trying to imply that all medical practitioners are corrupt, although one could generalize by saying that there are many bad apples in the barrel. The fact that, becoming a doctor these days is more exclusive than inclusive; as we can see from the ongoing fracas between the Government and the GMOA. The GMOA's rather drastic stand against private medical education is proof enough that the healthcare business is seriously turning into a mafia. If any profession needs transparency, more than others, it is certainly the medical sector. But patients are not being made aware and whether will ever be remains a big question, because politics also plays its own part. The GMOA therefore, may yet get its way, even if it is to the detriment of the greater part of our society.
Yes, any profession needs regulation, but something that works better than rules and policing are market forces. However, the manner in which students are selected for this hallowed profession seems rather homogenous or even incestuous by nature. The Z score on which much emphasis is placed in choosing A Level science students to State medical universities is marginalising students with higher scores and replacing them with low result students from so called underprivileged areas, all in the name of levelling the playing field socially.
Be that as it may, it is clearly important that market forces are given a chance to play in this area and the only way to do it is to open it up more and thereby reduce the doctor patient ratio to healthy levels. For healthcare indices to reach better levels, patients need to spend more time with doctors and this cannot be done when the country's doctor patient ratio is said to be approximately 1 is to 2,000. With approximately 1000 doctors entering the field every year, the quality of medical treatment is poor in this country and that is why it is not surprising that a visit to a hospital to meet a doctor is a generally a long wait, which sometimes means doctors seeing patients well past midnight.
Drug interactions
Why do you need to have more time with your doctor? This writer would like to give this example. When prescribing medicines to a patient, do they have time to ask about what other medications the patient takes. When pharmacies distribute, non over the counter, drugs to self-prescribing patients, there could be a huge clash in the medication taken.
For example, tablets containing Vildagliptin, used as a combination treatment for diabetes type II or prescribed to patients who cannot tolerate metformin, whilst being a wonder drug for diabetes has side effects that the patient should be made aware of. Common ones are that of dizziness and certain reactions with other anti-diabetes medicines. Vildagliptin should not be used in people who are hypersensitive, patients associated with liver problems or children under the age of 18. Dose adjustments are also necessary for those having serious renal problems. Metformin on the other hand may have side effects that are specific to manufacturers but the more common effects in its generic form are abdominal discomfort, cough or hoarseness, decreased in appetite, diarrhoea, fast or shallow breathing, fever or chills, general feeling of discomfort, lower back or side pain, muscle pain or cramping, painful or difficult urination and drowsiness.
What about cholesterol reducing statins? These come with a number of side effects out of which the more common include headache, difficulty in sleeping, skin flushing, muscle aches, drowsiness, dizziness, nausea or vomiting, abdominal cramping or pain, bloating or gas, diarrhoea, constipation and rash. Statins also carry warnings of memory loss, mental confusion, high blood sugar, and type 2 Diabetes as possible side effects. They may also interact with other medications taken.
There is also research on natural medicines such as ginger which is a known as a cure for many ailments, but may interfere with the dosage of insulin taken by diabetic patients because the spice is said to have propensities to increase the release of insulin in blood. The examples given here are but few, but there are so many others, especially when it comes to drugs prescribed for respiratory problems and a number of other conditions such as ADHD, Irritable Bowel Syndrome and the list is long.
How much of this information filter down to patients, do doctors have the time to discuss how prescription drugs work and the dangers of self medication, in an environment where prescription drugs can be got over the counter and where pharmacies not adhering to the rules.
What standards are being implemented to ensure that drugs introduced by pharmaceutical companies provide the full picture to doctors and ensure that doctors are wholly conversant with the side effects of the drugs they are prescribing. For example, if anyone goes to the doctor with the common flu the first thing most OPD doctors do is prescribe the highest dosage of antibiotics whether it is for an adult or child.
According to the Centre for Disease Control & Prevention (CDC), a staggering 30 per cent of antibiotics or medications given to patients to kill bacterial infections, prescribed more than 154 million times every year in the US alone, are unnecessary. Some reports even say that number is more accurately 50 per cent, which is a statistic that should make us all take pause.
Why? Because there are many consequences in taking antibiotics, especially when you don't really need them. For starters, using too many antibiotics has caused an epidemic of antibiotic-resistant infections. Bugs like MRSA — bacteria that resists many common antibiotics, are spreading like never before, in part, because of our overuse of antibiotics. There are also many direct side effects to antibiotic use. According to reports, many die each year from severe diarrhoea caused by these drugs, and many more have irreversible damage to skin, nerves and tendons apart from affecting their immune systems.
Ignorance
One of the reasons for this is that most doctors themselves are not aware of these side effects because they simply do not have the time to read the fine print and why so, one may ask.
The reason is it is humanly impossible to handle two jobs (Government hospitals during the day and hundreds of patients in private hospitals at night); where can they find the time or work up the inclination? If the GMOA was really concerned about the health care people in this country receive, should they be more aware of the ground situation and work on preventive measures. But this cannot be done because where health care and doctors are concerned we are in a seller's market. We have an under supply of doctors, and patients have to accept this substandard service.
In order to improve healthcare, policy makers need to target the area in which we produce more doctors. Yes, standards are necessary in seeing that the ones we produce are of a high quality, but then, that is the easiest part. Regulators and examiners are outside parties who can easily judge the levels of students coming from private institutions.
If having good facilities for clinical experience is a problem, the private sector could certainly do better than the Government in this area. What this country needs most importantly is to focus on priority and the elected Government understands this situation and thus the decision to go into non-state medical education, but not everybody seems to understand this solution, especially those who should - the GMOA.
tianamendis1@gmail.com
