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Patients … Heal Thyself?

July 28, 2005 By:
Frank Rosci, JE Feature
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In the United States, a potentially problematic medical trend has a growing number of people medicating themselves, as they turn the old phrase, "Physician heal thyself," to "Patient, heal thyself."

Even with the great wealth of medical information available today in self-help books and magazines, as well as on the Internet, this practice should be a reason for concern, say those interviewed.

This notion goes far beyond merely not consulting a doctor for minor medical issues like occasional aches and pains. These days, people are treating themselves for serious ailments that really only a doctor should handle.

How smart and safe is this?

"While a lot of people can perform self-diagnosis successfully, and it's a good idea for minor things - such as a sore throat or cold from a virus, which could include upper-respiratory congestion - those who do have to be very careful, and should definitely see their doctor if either symptoms persist for a couple of weeks or become worse in that time," says David Axelrod, M.D., an internal medicine associate at Thomas Jefferson University Hospital and instructor of medicine at Jefferson College.

"Also, they have to be aware that what they're treating themselves [for] actually could be a sign of a much more serious condition. Either a persistent fever or prolonged weight loss could [indicate] something more serious, just as heartburn and chest pain might really be a symptom of a cardiac problem and not simply indigestion."

One of the chief reasons more and more people are attempting to self-medicate is the proliferation of over-the-counter drugs in recent years, says Axelrod. "In the 1980s, about 30 percent of the U.S. population self-medicated. Now, with so many more drugs available over-the-counter and attempts at self-help so much more prevalent, the percentage certainly is a bit higher today," he cautions.

Another problem is people taking too many things in combination - what medical experts call polypharmacy - a term that can apply also to prescription medications. "By taking too many over-the-counter drugs, especially for too long a period of time, a patient can unknowingly do more harm than good. Ibuprofen, for example, can aggravate an underlying chronic renal condition, and with high enough dosages lead to kidney failure. With overuse, it can lead to gastritis," explains the physician.

Indicative of the self-medicating trend is the sudden appearance of at home tests for everything from HIV to the status of colon health.

"The primary and very real danger with these kits is getting a false positive in a setting where the patient doesn't understand the results, which may cause that person to take other medically unsupervised steps - not to mention acting to increase an individual's level of grief and anxiety," says Axelrod.

Such tests are so extensive that they now include full-body Cat scans being offered without a doctor's prescription in places like shopping malls.

Strike a Balance

A key to handling the self-medicating issue intelligently, he says, is for patients to strike a balance. In doing so, he adds, it's a good idea for patients to know themselves pretty well, including being realistic about their ability to self-medicate.

"An established relationship with a physician means the doctor will know a patient's personal and family medical history very well, and will then be able to treat conditions that arise," says Axelrod.

"This is especially helpful if and when a patient must be admitted to a hospital, for example, in terms of which drugs he or she may be taking, and also which others can be administered safely and tolerated well."

There definitely is a veritable explosion of self-medicating choices that has happened over the last five years, says Hal Hockfield, M.D., internal medicine, Abington Plaza Medical Associates.

Notes Hockfield: "The trend applies to many classes of drugs, such as antihistamines, including Claritin; anti-inflammatory drugs that include naproxen (the main ingredient in Aleve), ibuprofen and Motrin; and antacids, such as Pepcid.

"The concern is that patients, who use these and other drugs to treat themselves, may have an unknown, undetected and underlying medical problem or disease, such as diabetes or high blood pressure, that will be made much worse over time because over-the-counter drugs were introduced."

If there is a pre-existing kidney problem, for instance, two to four Aleve taken every day could cause internal bleeding, he warns.

Another area of self-help that bears watching, he says, is the use of herbal remedies. Some can act as stimulants and raise a patient's heart rate.

As Hockfield emphasizes: "Before taking any nontraditional substances and any over-the-counter drugs, especially new ones, it's best to either call or visit the doctor to see if they can be tolerated safely, notably if an underlying medical problem exists."

 

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