Thread by @hyderabaddoctor

A few patient consultations may not require prescribing medicines

1. When patients consult a doctor, in most cases, they expect a pill to be prescribed.
Vice versa, a doctor may feel compelled to prescribe a drug to ensure patient's satisfaction.
#doctor #patient #MedTwitter

2. There are some situations, where a medicine need not be prescribed. As a doctor, it is our duty to explain this aspect to the patient, so that un-necessary medicine prescription may be avoided. It can save costs as well as prevent any drug-related "adverse effects".

3. Case 1: 25-year old presented with pins & needles sensation in scalp for 3 days. It was mild & didn't interfere with daily activities. Patient was anxious that it could be something serious. Clinical exam was normal. I reassured the patient and asked to review, if needed.

4. Case 2: 32-year old presented with muscle aches & tiredness for 4 days. She had viral fever last week, and was afebrile now. Blood investigations recently done were normal. Clinical neuro exam was normal. I suggested simple measures for symptom relief & to review, if needed.

5. Case 3: 25-year old had 2 episodes of fits at age 3 and 5, associated with fever. She had no seizures after age 5. She was planning to get married and came for neuro check up. I diagnosed febrile seizures in childhood. No tests ordered & no medicine prescribed. Reassured her.

6. Case 4: 12-year old was brought with an episode of fainting after standing in school assembly on a hot morning. Neuro exam was normal. Clinical diagnosis was syncope. Explained in detail to parents, counselled them. No tests were ordered and no medicines prescribed.

7. Case 5: 33-year old presented with neck pain for 10 days. His job required sitting for 10 hours daily. MRI cervical spine done elsewhere showed mild disc bulges. Suggested physiotherapy, lifestyle changes & proper posture. Asked him to stop medicines prescribed by another doc.

8. Patients and family members were convinced that medicines were not needed in first 4 cases. However, in case 5, patient was not convinced and complained to hospital management that no medicine was prescribed, even though he travelled 250 km to see the doctor (me).

9. Take home message
*If there is no need, medicines need not be prescribed. Patients should be adequately counselled about the same.
*Vitamins, pain-killers and paracetamol are routinely over-prescribed: this practice may not be ideal and can even harm the patient in some cases.