Who doesn’t like free medicines? The geriatric population of every community just loves these medicines. Most of them come for regular monthly check-ups, test their blood pressure (BP), their blood sugar level, and also present their ailments (if any), The doctor titres the dosing of the anti-hypertensives, prescribes other drugs if needed and gives advice on lifestyle modifications to these patients. NCD clinics are conducted mostly on a fixed day of the week for the convenience of both the health workers and the patients.
There are some patients who are really poor and depend mainly on the public hospitals to continue their medications. That doesn’t mean that only the poorest in the community are eligible for these free services, There are many patients who believes that the medicines they get from the Government hospitals are of superior quality. Such patients take these medicines every day without fail. There are others who just come to the hospital just for the testing part and when they are done, they leave without taking the medications. These patients either do not require the free medicines or they might be comfortable on their current medications which they had purchased from a private facility. As you all might be aware of the fact that ‘over the counter’ purchase of many drugs is legal in India.
Free medicines are not confined to these NCD drugs alone. There are numerous costly preparations which are made available free of cost by the State Government.
It is really hard during the rainy season (commonly known here as the ‘fever season’) when the number of patients attending the Out Patient Department (OPD) rises geometrically. The patients know that they just need to take ‘Paracetamol’ for the fever, but they want the medicine not from any private hospitals, not from any medical outlets, but only from a Government hospital. This might be because of the various announcements and advertisements made by the Health Department regarding the management of fever prior to and during the rainy season. Antibiotics if prescribed by the doctor are supplied for the full course of the medicine.
I have often wondered whether the patients who are getting these free medicines are taking the medicines properly or not. So whenever a patient comes for a review, I ask the patients about how they consumed the medicines which they got from the hospital free of cost.
Simply because of the fact that these drugs are given free of cost doesn’t mean that they are of inferior quality. This is one of the biggest misconceptions among the patients. Others who are too lazy and who think that the doctor has over-prescribed him/her stops taking the medicines whenever he/she feels like. Mothers who bring their kids back to the OPD within two days of consultation, complaining that the fever has not yet subsided is not an uncommon incident here. If enquired, they will tell you that they gave the medicines two times on the first day and stopped it when the fever subsided. The prescription clearly instructs them to give the medicine every 6 hours and they just ignore it. Same is the case with antibiotics. Even if the doctor had prescribed the medicine for 5 days, the patient who gets his symptoms relieved after the first two doses of the drug simply stops taking the drug thinking that it’s enough.
Patients suffering from Hypertension and Diabetes are not different. They titrate the dosing of the medications as they please. Monitoring blood pressure and blood sugar level at home is a very good thing, and I do support it. But I don’t think the patients should titrate or adjust the dosage of the anti-hypertensive or any such drugs without consulting a doctor. When they get a headache or feel a dizziness, they think their blood pressure is high and pops in a pill even without checking the BP. Educating the patients about the type of disease and the medicines they take is one thing and it is completely different to educate them on adjusting the dosage of their own medicines. Such patients who think that they know their condition even better than the doctor should be made aware of the risks involved. Patient education cannot be done for every single patient by a doctor during the OPD hours. Health education is a whole new topic and we will leave it there.
In a country like ours, where public hospital infrastructure is average compared to the developed nations, supplying free medicines to the whole community is one thing which has to be appreciated very highly. The community also has to pay back the favour by not wasting the medicines and helping the health workers. Medicine wastage is a thing which cannot be afforded by our Government. Just think about it.