Playing doctor

Self-​medication may be fine in cer­tain instances but when those instances become severe, the only option is to see a doc­tor. Find out from Raf­fles Hos­pi­tal experts on when it is safe to self-​medicate …

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, Raf­fles Hos­pi­tal experts’ advise when it is safe for you to take over-​the-​counter (OTC) drugs, and when you should be see­ing a doctor.

1) FLU AND COUGH

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 as it 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, such as bron­chi­tis or pneu­mo­nia. In such cases, you may need antibi­otics to get better.

2) HEADACHE

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, warned 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.

3) SINUS AND RHINITIS 

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. He added that aller­gies to nasal decon­ges­tants are uncom­mon as these med­ica­tions are used to treat aller­gies. 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 such as in the case of a devi­ated nasal bone or pres­ence of nasal polyps.

4) CHEST PAIN

You may try self-​medicating when:

The pain is not exercise-​related, last­ing less than five to 10 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; or 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, shared 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”.

• Wrong dosage – Tak­ing the wrong dosage as rec­om­mended by the doc­tors can be haz­ardous, and will not help you recover faster. Many of us often think that by tak­ing more of the med­ica­tion, we will recover faster but this is far from the truth.

• Mix­ing sev­eral med­ica­tions together – 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

Some con­di­tions or even pro­ce­dures can be very well man­aged by gen­eral prac­ti­tion­ers (GPs). Dr Chow Kah Kiong, a spe­cial­ist in obstet­rics and gynae­col­ogy at Raf­fles Women’s Cen­tre, said that in these instances, patients could choose to be treated by GPs, instead of by spe­cial­ists such as for rou­tine PAP smears. The con­sul­ta­tion fees for GPs are lower, and often com­pa­nies will bear the cost of treat­ment by the com­pany doctor. 

This arti­cle has been reprinted with per­mis­sion from the Raf­fles Health News.

(PHOTO CREDIT: THE PILLS © Egortetius… | Dream​stime​.com)