Playing Doctor - Should you self medicate?

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When is it okay to self-medicate and when should you see a doctor? Experts advice on the best course of action for different common ailments.

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Do you often rummage through your medication box, in search of medication that you believe will resolve the ailments you are suffering from? Many people have no qualms about self-medication.

While the ‘do-it-yourself’ attitude towards medical treatment is usually not advisable, it does not seem practical for you to be at the clinic every time you feel under the weather.

Here are our experts’ take on when it is safe for you to take over-the-counter (OTC) drugs, and when you should be seeing a doctor.

Flu and Cough

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You may try self-medicating when:
You are suffering from a minor cough, sore throat or runny nose. “However, it is usually not advisable to take OTC cough and cold remedies for over one/two weeks.” said Dr Rupert See, Senior Physician at Raffles Medical.

Certain OTC medications may cause drowsiness and this is usually indicated on the label. You should not be driving or operating machinery when you are on these medications. Another point is, if you are allergic to “painkillers” (usually a class of drugs called NSAIDs or non-steroidal anti-inflammatory drugs), you should be careful about taking medicines like Nurofen. Nurofen contains “ibuprofen”, a type of NSAID.

A visit to the doctor is inevitable when:
You have more severe symptoms like high fever, body aches and/or chesty cough. These symptoms may be indicative of more serious conditions, e.g. bronchitis or pneumonia. In such cases, you may need antibiotics to get better.

Headache

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You may try self-medicating when:
You suffer from the occasional headache that is not severe and there are no other symptoms such as fever, neck stiffness, drowsiness, numbness, weakness, or inability to speak. You may also self-medicate if you had consulted a doctor previously and were given medicine to take when the headache is severe.

The only licensed oral pain reliever available in Singapore is paracetamol. Other painkillers and migraine medications require a doctor’s prescription. Dr Alvin Seah, Specialist in Neurology at Raffles Internal Medicine Centre, warns that overusing paracetamol may lead to a syndrome called medication-overuse headache, which is very difficult to treat.

A visit to the doctor is inevitable when:
The acute headache is very severe, or is accompanied by fever, neck stiffness, drowsiness, numbness, weakness, or inability to speak, especially if you are not suffering from migraine.

You should also seek a doctor’s advice if the headache keeps recurring, or is getting worse, despite self-medication.

Sinus and Rhinitis

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You may try self-medicating when:
You have been experiencing blocked or runny nose for a few weeks. You may also continue using the medicine that had been prescribed by your doctor, if you had consulted one previously for your condition.

“Most OTC medications are safe. Most nasal decongestants can be used for short term with minimal side effects,” shared Dr Aw Chong Yin, Specialist in ENT Surgery at Raffles ENT Centre.

Dr Aw added that allergies to nasal decongestants are uncommon as these medications are used to treat allergy. However, nasal decongestants with pseudo-ephidrine may cause insomnia or the heart to beat faster. Some, like chlorpheniramine, may cause drowsiness.

A visit to the doctor is inevitable when:
Your symptoms are chronic, if medication is not resolving them or if you experience bleeding from the nose or blood-stained phlegm. Locally there is a high incidence of nose cancer (nasopharyngeal carcinoma). It would be prudent to have clearance from the doctor first before taking long term medication. Sometimes medications do not work due to structural problem e.g. deviated nasal bone, presence of nasal polyps.

Chest Pain

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You may try self-medicating when:
The pain is not exercise related, lasting less than five to ten minutes. Symptoms of benign chest pain include pain that is described as brief and sharp / knife- like, recurrent chest pains that are not consistent in quality (and not akin to a weight on the chest), pain that worsens with turning around or coughing and pain that occurs after large meals and when lying flat. In the above cases, a muscle relaxant or non-steroidal anti-inflammatory cream may be useful. “You can also try taking antacid, particularly if symptoms occur after a large meal and when lying flat after eating,” said Dr Antono Sutandar, Specialist in Cardiology at Raffles Heart Centre.

A visit to the doctor is inevitable when:
Chest pains should not be taken lightly as they can be indicative of larger health problems. Seeking advice from the professionals can thus be your best bet in these instances.

Symptoms of a heart attack include:

  • Chest pain with activity and decreased functional status (pain with lower and lower level of activity)
  • Chest pain described as pressure / weight on the chest
  • Chest pain associated with feeling of constriction of the throat - jaw / radiating to arm
  • Chest pain associated with shortness of breath

A symptom of the presence of a blood clot in the lungs is chest pain upon taking deep breath, associated with recent long distance travel and shortness of breath.

A symptom of an aortic dissection (i.e. a tear in the blood vessel wall of the aorta - the largest arterial blood vessel structure that comes out from the heart) is an extremely painful chest pain as if somebody is tearing you apart inside.

Rules of the game

Self-medication may not necessarily translate into cost savings. Dr Wong Wei Mon, Senior Physician at Raffles Medical, shares with us, some costly mistakes you could possibly end up making.

Not finishing the course of antibiotics
Many patients have the habit of not finishing their course of antibiotics and saving the remainder for future use. This is very dangerous as it brings to question if the initial illness actually calls for antibiotic.

If it does, then the antibiotic has to be completed to fully eradicate the bugs. If an antibiotic is not needed, then they should not be asked for or prescribed. This habit of not finishing the course of antibiotic is tantamount to misuse and will certainly breed resistance and the emergence of “superbugs”.

Read on for more common mistakes we make while self medicating...

Wrong dosage
This is especially common and potentially fatal in children. Paediatric syrups can come in various concentrations. Dosing depends on the body weight of the child.

Hence in a growing child, the weight of the child increases with time and a particular dose of medication prescribed three months ago may not be the correct dose presently.

Mixing several medications together

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Even when the right medication and the right dose are used, self-medicating can be harmful when mixing of medications happens.

Several problems can arise, such as drug interactions, overdose due to cumulative dose of the same ingredient in different medications, and delayed proper treatment for seemingly minor symptoms which are in fact more serious issues.

Taking the wrong medication
Panadol is a drug that is commonly abused. People take it for headache, flu-symptoms, abdominal pain, insomnia and the list goes on. While this may not kill, it can certainly prevent one from getting better.

A cost-saving tip from the expert

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Some conditions, or even procedures, can be very well managed by general practitioners (GPs). In these instances, patients can choose to be treated by GPs, instead of by specialists. For e.g., in Obstetrics & Gynaecology - shared antenatal care in uncomplicated pregnancies, routine PAP smears and uncomplicated insertion of IUCDs. The consultation fees for GPs are lower, and often companies will bear the cost of treatment by the company doctor.

Dr Chow Kah Kiong, Specialist in Obstetrics & Gynaecology at Raffles Women’s Centre

This article is provided by Raffles Medical Group. For more information visit http://www.rafflesmedicalgroup.com/