How would you feel? If you rushed to the nearest clinic in your neighbourhood with a feeling of some body malaise, but after a series of medical tests and physical examination, the doctor at the clinic tells you that you actually didn’t need any medication or that, you simply needed bed rest?
To Mr Leonard Kizito, 27, a resident of Mabibo in Dar es Salaam, that would simply mean that the doctor does not care about the patient’s feelings—or in other words, it would appear to him that the doctor in question was insensitive, so to speak.
“May be I would go to another clinic and prove if the doctor was serious or not,’’ says Mr Kizito. “I would also think that I paid my consultation fee for no purpose,’’ he adds.
Mr Kizito believes that a good doctor should be reliable and able to fix every problem. “Not putting off patients.’’ It does not make sense to him, when a doctor can “simply’’ refuse to offer any medication to a patient.
Kizito’s belief about doctors is one that is shared among a section of people in society—but not all. Others, Like Aneth Zakaria, 26, a journalist in Dar es Salaam, thinks differently.
Aneth, for example, has come to learn that not every time she visits a hospital with some symptoms, a doctor must give her tablets or even an injection for whatever symptoms she may report.
“In fact, I have come to realise that unnecessary prescription of medicine could be harmful,’’ says Aneth as she recalls a scenario in the past, when a medical officer at one government hospital advised her to shun from the belief that every symptom must be treated with medication.
As medics go about their routines at various hospitals, they are confronted by patients who may want medication to every symptom. A typical case is when Dr John Ngowi of Mwananyamala Hospital was forced by one of his patients to prescribe antibiotics, even when it was not necessary.
“That patient told me that he had already diagnosed himself and he really felt he was suffering from Urinary Tract Infection (UTI),’’ says Dr Ngowi as he tells his story of an encounter with what he termed a “controversial patient.’’
“He first told me he did not need any medical tests but after some minutes of trying to educate him, we took samples of his urine and blood to the laboratory,’’ Dr Ngowi goes on.
“Surprisingly, the results came negative and there was no need of giving him antibiotics. May be some anti-pains. But he insisted that I should give him some antibiotics. The patient could even mention the types of the medicines he wanted,’’ the doctor narrates.
“You see, not every time you have a fever, or you feel weak, you need tablets,’’ advised Dr Ngowi. “Sometimes you could have a viral infection that does not require medication. The commonest viral infections usually go away with time, even without medication,’’ he continues.
Dr Ngowi has come across several other people who decide to prescribe antibiotics to themselves without going through medical tests. “One person told me that he has already mastered his symptoms. So he usually takes some antibiotics without consulting a doctor,’’ says Ngowi.
The doctor says this habit has hugely contributed to drug resistance and further warns that lots of anti-malarial drugs have been phased out because they were rendered ineffective through abuse by the users.
Medics too share the blame
While ordinary people carry their own share of the blame in the irrational use of medication, some experts argue that health workers can also be faulted on this. Studies done in Dar es Salaam have also highlighted the health-worker-factor in irrational prescription.
One renowned professor, Prof Gilbert Welch, the author of a famous medical book—Less Medicine, More Health–7 Assumptions that Drive Too Much Medical Care, came out to admit the health-worker factor in unnecessary prescriptions recently.
He put it quite explicitly that health workers may fail to resist the pressure from patients who may want medications from doctors even when there is no medical reason.
Professor Welch, from Dartmouth Institute for Health Policy argues that some doctors may feel caught in a dilemma that, if they don’t prescribe medicine, patients might be dissatisfied and go elsewhere.
‘‘...we [doctors] also feel pushed to act because many patients have been taught to believe that the good doctors can reliably fix problems by trying out medications, ordering tests, and referring to specialists.’’
But, he warns, ‘Knee-jerk medicine is not good for the patients. “More medications, more testing and more referrals quickly add up to real money coming out of your pocket,’’ he wrote in The Wall Street Journal recently.
The don further warns that the harm can be more than financial. Some diagnostic tests may wrongly detect a problem in a normal patient and necessitate an operation that could have been avoided.
However, there is more to that. While the patients can benefit more by trusting health workers, some studies indicate that the patients need to be watchful with their choice of the experts they go to.
One study, done two years ago, titled: Knowledge among drug dispensers and antimalarial drug prescribing practices in public health facilities in Dar es Salaam, revealed “inappropriate’’ dispensing practices in the city.
About 84.6 per cent of drug dispensers were found to have poor knowledge regarding the basic information required from patients before dispensing recommended antimalarial drugs.
The researchers recommended that regular on-the-job training and continuing education should be provided to drug dispensers and prescribers in public health facilities.
A way of raising revenues
But also, the mushrooming of private health clinics in the city has been under scrutiny after some studies alerted, in the past years, that owners of some of the facilities were raising their revenues by over-prescribing injections and other antibiotics.
A study published some years ago in the Asian Pacific Journal of Tropical Medicine noted that some medicines offered in form of injectables were overprescribed in many developing countries including Tanzania—warning that the demand and use of injections was driven by both the health care providers and the patients.
“Even if the clinicians refuse to provide them, the same patients can still buy them from drug shops without the doctors’ prescription and get injected in their households by untrained people,” the study reads in part.
“On the other hand, clinicians, especially in the private health facilities, gain some money from additional charging of the injections prescribed or administered,’’ reads the study, titled: Dangers of injection overuse in developing countries with a high HIV/Aids prevalence.
Other studies done locally show that over 70 per cent of patients attending out-patient clinics at private dispensaries receive at least one injection per consultation--higher than the WHO recommended target of 10 per cent.