Medicines has greatly helped to prevent, cure and control several diseases which has resulted in good health and prolonged longevity. These drugs undoubtedly bring relief to patients with various illnesses, but the fact remains that none is free from side effects. Thus, their benefits have to be weighed against the risk involved based on the scientific medical knowledge and clinical experience of the physicians.
As often said, the most important thing in medical practice is ‘Diagnosis’ of a disease. Different diseases may have similar symptoms and manifestations with totally different cause which need to be differentiated based on laboratory tests for getting the right medicine i.e. one which is highly effective with minimum adverse effects. The physicians have a professional, social and moral responsibility to provide the best available treatment to their patients. Similarly, patients also have an equal responsibility to use medicines as per the doctor’s/pharmacist’s instruction for best results. However, the scenario is far from desired. Several studies have revealed that a good percentage of patients fail to follow the instructions and consume drugs as per their convenience and belief towards the prescribed medication.
Self medication can be viewed from two angles:
- Modifying the instructions given by the physician (Noncompliance) and taking medicine as per the convenience.
- Procuring and consuming medicines without medical consultation.
Patient noncompliance is identified as a major factor in therapeutic failure in routine practice. It is often assumed by the doctors that patients will gratefully or accurately follow what they are told, but the assumption is wrong. The patients adherence to the medical advice and instructions may be partial, erratic or nil. This may be due to several reasons:
- The patient has not understood the instructions
- High frequency and complexity of drug regimen
- Multiple drugs
- Forgetfulness
- Willful noncompliance
- Poor labeling on the containers
- Poor patient doctor relationship
- Failure to refill the medication
Some patients are over enthusiastic to take the drugs and may take more drug than is prescribed. This is generally because of their belief that more drug means faster and more relief. Appropriate steps can be taken to improve the patient’s ability to follow the instructions regarding drug procurement, storage and usage and get maximum benefit from the medicines prescribed.
The other angle to self medication is procuring and consuming drugs without medical consultation or prescription. The process is generally based on ones judgment, observation, experience, and confidence regarding the use of medicine. Some consumers are able to manage uncomplicated chronic and recurrent illnesses after proper medical diagnosis and occasional professional advice. The individuals are not willing to visit the doctor for what they rightly feel they can manage for themselves with their medical knowledge and previous outcome with the earlier use of medicine. However, this is not recommended as it may not give the desired therapeutic effect. Moreover, it may sometimes lead to worsening of the disease or end up with severe and serious side effects requiring hospitalization. The indiscriminate use of drugs, particularly antimicrobials, will increase the chances of drug resistance and therapeutic failure. It is noteworthy that more than five per cent of the hospital admissions are due to adverse drug reactions.
Some of the factors that promote and favor self medication are:
- Satisfactory previous experience
- High physicians consultation fee
- Lack of Time to visit the physician
- Overconfidence about one’s medical knowledge
- Drug experience sharing with relatives and friends
- Easy availability of all sorts of medicine
- Freedom to start and stop the medication
- Home storage
- Drug information from internet
The most common factor which promotes self medication is the information dissemination by friends and relatives who take pride in recommending the medicine, which has benefited them, to anyone having similar manifestations. Unfortunately, they consider it as their moral and social responsibility to share such useful information with others for the benefit of one and all. They generally end up giving incomplete information due to ignorance which may prove dangerous if accepted in good faith.
It is noteworthy that the successful outcome of taking medicine without prescription  is the self–curing nature of several illnesses which do not require actually require any treatment which gives encouragement and confidence to the patient and he adopts the same approach for serous diseases requiring specific medication. Moreover, patient’s complaint being resolved is generally considered as an achievement ignoring the fact that the underlying disease may be progressing well without the alarming signs and symptoms. It must be remembered that the effects of a medicine show large interindividual variation depending upon ethnicity, age, Physiological status, smoking and alcoholism, Pregnancy, presence of other diseases, concomitant drugs etc. These need to be taken into consideration before popping a pill. Some of the drugs called   ‘over-the-counter’ are largely available without prescription from the pharmacies or via any retail outlet drugs are generally considered safe which is not the case and must be used with caution.
In a nutshell, it is simply safe and surely better to be in the hands of a physician who prescribes an evidence-based effective treatment and gives proper instructions for its use in a safe and effective manner.
LET’S SAY NO TO ‘SELF-MEDICATION’ TO AVOID MISUSE, OVERUSE AND ABUSE OF GOOD MEDICINES.
Dr. Anoop K. Agarwal
Department of Pharmacology
Gulf Medical University, Ajman
