Without dithering a bit, trendy self medication for all trivial ailments, even if it is of few minutes duration is very common in the Valley. People with common cold often resort to antibiotics and anti-cold preparations. This condition will otherwise settle on its own within a week. For almost every viral or allergic illness, patients are loaded with antibiotics, and this fashionable trend is fueled by patients themselves. Whenever any physician refuses to prescribe antibiotics, either the patient himself or others let them take antibiotic, playing with their own well being which unfortunately is being imitated by many well trained medicos as well. This is not the case of just providing antibiotics to all whether they need or not, or to be on the safer side for the patient as well as for doctor.

The thing to ponder is something far bigger than just taking these antibiotics, as we are heading to an arena where all antibiotics will be useless and curable infections will turn in malignant infectious conditions, as all microbes will turn resistant to all available antimicrobials. Because rate of resistance acquired by these microbes is far higher than the newer antibiotics being developed.

Pan-drug resistant tuberculosis is an example where no drug is effective in this otherwise curable disease hence called infectious malignancy, a far dangerous fatal condition than a cancer in itself. This infectious malignancy can spread very fast to any person who comes in contact; nevertheless if someone is suffering from a cancer a non-communicable entity, there is no chance that it will spread to any person coming in contact. 

Whether it is medical uncertainty to order lot many tests, or saving ones reputation as a great doctor and prescribing all antibiotics, or it is avoiding legal issues for any incidental condition even if it is benign, or false reassurances to go for unnecessary procedures, all amount to defensive malpractice, a trend ramifying very fast. The Congressional Office of Technology Assessment (OTA) in USA provided a useful definition of defensive medicine which states “Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability. When physicians do extra tests or procedures primarily to reduce malpractice liability, they are practicing positive defensive medicine. When they avoid certain patients or procedures, they are practicing negative defensive medicine.”

It affects patients as well as physicians. All those involved in the healthcare system would presumably accept higher levels of monitoring and testing if such actions guaranteed better results. Some researchers have indicated that the chance of uncovering a malignant cancer in patients by using repeated CT scans was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation.

We are not going to become a healthier society by doing unnecessary medical tests on patients and administering all possible antibiotics, who think that, is the only answer to all of their health problems. Patients deserve our tender approach and expert consultation, they need to hear what we would recommend and why, and what are the possible ramifications of pursuing different courses, while restricting them from self judgments. Giving them a list of unfiltered options as though every choice is equivalent is really an abdication of our professional responsibility. All patients I think are worrywarts who would not, and could not, rest assured till they are out of the obsessed idea of their illness, where a doctor must apply art and science together to bring him out of abstract. 

Bottom-line: Formulating uniform guidelines and protocols for all potentially life threatening conditions and step-wise management for every such patient could substantially reduce the defensive medical practice. The government also needs to protect physicians from the threat of a lawsuit if indeed a statistical certainty occurs with a bad outcome, after he/she has followed routine clinical protocols.

Definitely it will take us years together to reach Swedish health care delivery system where doctors do not feel compelled to order unneeded tests and procedures, or administering unnecessary antibiotics. Further, patients who are harmed are fairly compensated, under Patients’ Compensation System. Suppose a patient who had been medically harmed could file a claim for review by a panel of experts. If that panel deemed avoidable harm has occurred, the claim would be forwarded to a compensation board to award payment. This no-fault system would create a predictable model where patients would know their cases would be heard. Doctors would know they would not be hauled into court.

At last but not least, a heightened awareness is needed through all available media, to educate the society about the menace of self medication, about dictating physicians and surgeons about the misjudged problems, and about cultivating disbelief among one another. Never assume good doctors practicing bad medicine just to keep their patients happy.

(From RK Archives)