Doubtful benefits

A major group of patients who come to us are those with non- communicable diseases being treated elsewhere who just cannot bear the cost of treatment. Of course, most of the extra expenses are a result of multivitamins and latest combination drugs which are expensive.

However, I was quite surprised to meet a well off gentleman who came to me last week. He was diagnosed to have diabetes and hyperthyroidism elsewhere. He was incurring a cost of 7000 INR every month just to purchase the medicines. Doctor consultation costs and blood tests were extra. He had met another doctor who told him that there was no need for so many medicines.

He came for a second opinion.

His original treating doctor was no small man. He was a senior cardiologist in a NABH accredited hospital in a state capital city of our country.

The best I could do was to call up one of my friends in the respective speciality.

The below snap shows the medicines he had with him. In the foreground is the medicines he absolutely needs and behind it are the medicines he could do without, which has not much evidence of significant benefit.

A close up of the medicines we stopped. The protein powder and the sucralfate syrup is included.

Now, this is a patient who can afford to spend 7000 INR. One can only imagine the plight of the poor who are given a similar prescription . . .

Well, I hope you looked at the second snap, which shows the medicines he stopped a bit close . . . In that bunch of medicines, I hope you noticed Tab. Faropenem 200 mg. The gentleman was having it twice a day since the last 10 days. I could not find any evidence of any sort of infection in the papers he had nor did he give any history of the same. 

So much for evidence based medicine and the dangers of antibiotic resistance that we talk about . . . 

Gullible Patients

Over the last few days, it has been quite busy. The reason that my blog was silent was partly because of laziness and partly because of my not being on call during these days. Winter is yet to leave us and the number of patients at night are not that much. However, we’ve had our share of very very sick patients, most of whom found healing.

One of the common things we find here are patients who have been rather embezzled of their money by doctors who are a shame to the profession.

We had a typical one today.

The lady, MeD, a 28 year old who’s being married for about 10 years came in labour. Although this was her third pregnancy, she did not have any live issues. Both her previous pregnancies had died, the first one died within a day of the delivery which had taken place at home; the second one died within a week of delivery in a clinic.

Both deliveries had one thing in common – the labour was a long affair and the baby had not cried at birth.

Well, I was surprised to see quite a hugh file being brought in by the relatives. She had been on treatment from one of the posh hospitals in a faraway city to ensure that this baby survived.

As I went through the records, I was stunned to find out that MD had undergone all possible evaluation for infertility . . . her second delivery was not even one year back.

The list of investigations was huge . . . I saw one bill which totalled about 20,000 INR. Even after she had conceived, she underwent serial ultrasounds . . . I asked the husband if he had any information on why the previous two babies died.

She also received quite expensive medications which I thought was not at all needed. 

He told me that he was told that the VDRL was positive. However, all the records of both husband and wife showed that VDRL was never positive. And it was so surprising that the husband was all praises for the doctor who was rather looting them.

It is so so sad to see a young poor couple taken for a ride like this by a clinician who had multiple degrees printed after his name. 

By the way, MeD delivered within half an hour of her arrival into the labour room. The mother and the baby has been doing fine so far and we thank the Lord that we could be part of the joy of this couple. However, I’m horrified at how this poor couple has been fleeced off quite a lot of their money and they being of the impression that they’ve had the best treatment possible to ensure a live baby.

The couple was all praise for the big hospital in the city who gave them all the 'world class expensive treatment' that has ensured a healthy baby . . . of course, the joy was immense as it is a boy baby. The previous two who died were also male babies . . .

Managing diarrhoea . . . Complicating things

Yesterday, I was taking rounds when I came to a little boy, 11 months. He looked irritable and took my presence with much protest. I wondered why he should be admitted. 

The case sheet showed - 'Loose stools: 3 days. Being managed elsewhere. Baby has no relief'. 

There is no history of fever or any difficulty in feeding. There was couple of episodes of vomiting which has since settled . . .

I was interested in the 'management elsewhere' - 

And these were the list of medicines the little child was on - - -

1. A combination syrup of Salbutamol and Guiphenasin: 5 ml three times a day. 

2. Inj Ceftriaxone and Tazobactum - twice a day

3. Resicadrotil drops - 20 drops twice a day

4. Syr. Colistin Sulphate - 3 ml thrice a day

5. Inj Amikacin - one injection a day since the last 3 days

6. Neopeptine drops - 20 drops at night

7. Promethazine + Paracetamol syrup: 5 ml thrice a day

8. Ofloxacin + Metrogyl syrup: 5 ml thrice a day

9. Probiotic powder (Lactobacillus)

10. Dicyclomine drops: 5 drops thrice a day

11. Syrup Loperamide: 2 ml when needed

Well, I wonder if the little boy needs food at all . . . There would be no space in his little tummy after he's taken all those syrups . . .

This is the knowledge many of our doctors have about managing diarrhoea. 

You don't want to miss anything - so hit all the bacteria you've heard about or use all the antibiotics whose name you've heard of . . . I'm sure that if they had heard about any anti-virals, that would have also been started. . .

Below is a snap of all the medicines . . .

The worst part of the prescription. There was no Oral Rehydration Solution at all. . . If the doctor had added ORS to the prescription, that would have made it 12 medicines to treat a case of diarrhoea. . . 

We've stopped all medications. The baby's doing well . . .