New Delhi: At the end of April, a patient approached Dr Ashwani Goyal, a general practitioner in Delhi, breathless. The patient had all the obvious symptoms of Covid-19 and eventually succumbed to the disease. Seeing a doctor sooner might have saved his life, but he only got to Dr Goyal’s door when his condition became critical. This is a trend that Goyal observed often during the Covid-19 pandemic.
“He took a prescription from a family member, written by a pulmonologist, and immediately started taking these drugs instead of seeing the doctor first. By the time he came to see me, his oxygen was at 72 and I had to refer him elsewhere. I found out later that he was dead, ”Dr Goyal told ThePrint. “This is not a stray case, there are countless such cases,” he added.
Among the medications the patient had started, Goyal said, was the antiparasitic ivermectin, in addition to the antibiotics doxycycline and azithromycin.
In the revised guidelines issued on May 27 by the General Directorate of Health Services (DGHS), which reports to the Union Ministry of Health and Family, the mention of these drugs had been deleted, just like that of hydroxychloroquine, zinc and vitamins, although the latest rules set out on the The ministry of health (updated May 24) and Indian Council of Medical Research (May 3) websites suggest otherwise.
As the second wave of Covid took hold in India and flooded hospitals, many patients resorted to self-medication, which was also reported in the first wave. Prescriptions were shared among acquaintances on WhatsApp, and people anxious to develop severe Covid infection skipped the pills, often without individual medical consultation.
Doctors say lax oversight in pharmacies has fueled the trend, and constant updates to government guidelines – which typically define when a drug cannot be administered without medical supervision – have fueled the confusion.
“The guidelines changed quite frequently, which made the situation very confusing for doctors and patients,” said Dr. Goyal, adding, “Over time, we can see changes in the way people work. self-care, but they will continue to exchange prescriptions on WhatsApp and consult their friends. It happened before Covid too. “
Read also : “Fearing Covid”, Indians burst ivermectin, HCQ, dexamethasone – all self-prescribed
Why patients self-medicate
As noted by Dr Goyal, Indians have been associated with a propensity for self-medication, the side effects of which include side effects and drug resistance.
A 2020 meta-analysis from 17 self-medication articles in India found that the practice had an average prevalence rate of 53.57 percent, and that the most common reasons for self-medication included minor ailments and familiarity with medications. Another reason given was “the lack of regulation of over-the-counter drugs and the failure to adhere to rational drug use practices and policies”.
Doctors say the pandemic has exacerbated these trends, aided by social media, changing drug guidelines, increased health anxiety and a bombardment of information about new drugs and treatments for Covid- 19.
“Initially, it was hydroxychloroquine, then it became ivermectin and doxycycline, then azithromycin. Now it’s remdesivir and steroids, ”said Dr Jugal Kishore, head of community medicine at Safdarjung Hospital in Delhi.
“Pharmacies distributed them to people in packs, sometimes mixing them with Ayurvedic treatments like Coronil.”
Like Goyal, Dr Kishore says government guidelines are for doctors and people to follow, but cannot be strictly enforced.
Dr Rajeev Jayadevan, endocrinologist and former president of the Indian Medical Association, who has lectured several times on irrational drug use during the pandemic, described the trend towards self-medication – and over-medication – as a vicious cycle .
“When patients turn to doctors, they expect them to ‘do something’ – prescribe medication, in other words. It’s not uncommon for doctors to be asked why they don’t prescribe certain drugs, ”said Dr Jayadevan. “Doctors and patients compare prescriptions with each other, which has created a sort of unhealthy vicious cycle. The immediate availability of drugs in pharmacies and the lack of strict regulations allowed this to happen. “
Role of mental health
Patients with particular health concerns can also visit online forums and discussion forums, in addition to looking for online consultations.
“A patient will usually come to the hospital physically when he has really good reasons to do so. But with online consultations, doctors are just a phone call away. I am getting more and more calls for minor issues and from overly cautious people, ”said Dr Sampath Chandra Prasad Rao, cranial surgeon at Manipal Hospitals in Karnataka.
“The very fact that people resort to online consultations, when they are superfluous, indicates that people are anxious about Covid and other diseases. I know many around me who suffer from this anxiety.
Doctors from the Government Institute of Medical Sciences (GIMS), Noida, have found a strong bond between health anxiety and the tendency to self-medicate. The study, conducted during the first wave of Covid-19 in 2020, included an online survey. Of the 1,100 responses, a quarter “of respondents reported self-medication, 60% of which were anxious”.
Among those who self-treated, 56.6% were doing it for the first time, according to the study. “The drugs were taken mainly for symptoms such as headache, abdominal pain, ghabrahat (anxiety) and inability to sleep, ”the study added.
The most commonly used drugs were nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen.
“We did this study in the first wave, it must be a lot worse now,” Dr. Bharti Bhandari, one of the study’s co-authors, told ThePrint.
Read also : Self-medication for Covid has become disastrous. Families should not take on the role of doctors
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