All of us ‘play doctor’ to ourselves, some more so than others.
You are self-medicating when you reach for that Panadol whenever you have a headache, skipping a visit to the doctor in the process. Self-medication is the use of non-prescription medicines by people on their own initiative, according to the International Pharmaceutical Federation.
‘It requires consumers to make their own decisions in selecting and using medication to relieve or treat their medical conditions,’ said Ms Lita Chew, vice-president of the Pharmaceutical Society of Singapore. Responsible self-medication entails recognizing when self-treatment is appropriate and when a visit to the family doctor for diagnosis and treatment is necessary,’ she said.
Besides saving on doctors’ fees and prescriptions, people who self-medicate help take the pressure off medical services, which are often over-subscribed. However, while many minor ailments like fungal skin infections or the common cold can be treated with medicine bought over the counter, medical professionals caution that there are limits to self-medication.
Ms Quek Zhi Yuan, a pharmacist at the department of pharmacy at National University Hospital, said someone who self-medicates may be unaware of a drug’s dosage range or whether a drug is suitable. He thus risks an overdose or taking the wrong medicine.
Dr Wong Wei Mon, a senior physician at Raffles Medical, said: ‘Even with the right medicine and dosage, self-medication can be harmful if medicines are mixed. ‘Problems like drug interactions and overdose due to cumulative doses of the same ingredient in different medicines can arise.’ He added: ‘Many patients do not finish their course of antibiotics but save the remainder instead. ‘This habit of not finishing the course of antibiotics is tantamount to misuse and will cause resistance and the emergence of superbugs.’
Self-medication may also mask a more serious illness by resolving its symptoms without curing it. This may lead to a delay in seeking proper medical treatment.
A spokesman for National Healthcare Group Polyclinics said: ‘A persistent cough may be caused by an unresolved chest infection or tuberculosis, or, if present with other symptoms, lung cancer.
‘Sometimes a symptom can indicate a more serious underlying problem and the continued use of self-medication may delay proper investigation, treatment and management of the condition.’ While the practice is often no cause for alarm, Dr Rupert See, a senior physician at Raffles Medical, cautioned that self-medication should not go on for more than a week, especially if the symptoms do not improve. He said: ‘When in doubt, always see your doctor for further advice.’
Mind Your Body investigates when you should or should not self-medicate.
FLU OR FEVER
When to self-medicate: If you have general symptoms like a minor cough, sore throat or runny nose.
When to see a doctor: Dr Wong Wei Mon, a senior physician at Raffles Medical, advised seeing a doctor if the fever brings about changes in your mental state or has not subsided after two to three days. This is because there are many causes of fever from the common flu to urinary tract infection to malaria.
Ms Quek Zhi Yuan, a pharmacist at the department of pharmacy at National University Hospital, said children, the elderly and patients whose immunity is low should not be allowed to have a running fever longer than two days.
Self-treatment options: Anti-pyretics like Panadol.
RUNNY OR BLOCKED NOSE
When to self-medicate: Dr Wong said: “If you had previously been diagnosed with, say, allergic rhinitis, and a doctor had done checks and given you advice on how to use certain medicines, then self-medication is fine.”
When to see a doctor: A doctor’s review may be needed to exclude more serious conditions like sinus infections or nasal pharyngeal tumours, said Dr Wong.
Ms Lita Chew, vice-president of the Pharmaceutical Society of Singapore, added that you should see a doctor if your runny or blocked nose persists.
Self-treatment options: You may buy over-the-counter solutions or use the medicine that your doctor previously prescribed.
Self-treatment options include the use of antihistamines like Clarinase and decongestant nasal sprays like Afrin. However, overuse of the latter can lead to rhinitis medicamentosa, a condition of rebound nasal congestion where the nasal mucous membrane becomes inflamed.
STOMACHACHE OR CONSTIPATION
When to self-medicate: While mild or occasional constipation can be treated with over-the-counter medicine, stomachaches are a more dicey matter.
When to see a doctor: Ms Quek advised that persistent or progressive stomachaches should be evaluated by a doctor.
Dr Melvyn Wong, a senior physician at Raffles Medical, said: “The general rule is that if you find the symptom unusual and you don’t know what could be causing it, go see your doctor first.
“The abdominal area does have many organs, each of which can potentially give you symptoms. Most of the time, the symptoms may not be serious but there are times when they could indicate life-threatening conditions like appendicitis or colorectal cancer.”
If constipation is accompanied by severe abdominal pain, blood in the stool or vomiting, you should stop self-medication and see a doctor.
Self-treatment options: For stomachaches, you can get mild anti-spasmodic medicine like Buscopan or Meteospasmyl. For constipation, you can take fibre in the form of Fybogel, osmotic laxatives like Lactulose or stimulant laxatives like bisacodyl.
COUGH
When to self-medicate: If the coughing is occasional or acute without other symptoms.
When to see a doctor: Ms Quek said: “A chronic or persistent cough should not be treated by self-medication. If there is phlegm build-up or change of colour or signs of blood stains in your phlegm, see a doctor.”
If your cough drags on and there are other symptoms like fever or breathlessness, seek medical attention.
Self-treatment options: Cough suppressants like dextromethorphan, expectorants to induce coughing like Guiatuss and Robitussin or mucolytics which dissolve thick mucus and relieve breathing difficulties like Bisolvon.
Traditional herbal remedies like Nin Jiom, a traditional herbal expectorant which provides relief of productive coughs, also work.
NAUSEA
When to self-medicate: If the nausea is occasional or short-term.
When to see a doctor: If the nausea persists or becomes a frequent occurrence.
Self-treatment options: Ginger supplements, cinnarizine and dimenhydrinate (used to prevent and treat nausea, vomiting and dizziness caused by motion sickness) or promethazine (used to prevent motion sickness and treat nausea, vomiting or pain after surgery).
HEADACHE
When to self-medicate: If the headache is occasional, mild and if there are no other symptoms like fever or numbness, or it is a tension headache (which makes up 90 per cent of all headache cases).
Dr Rupert See, a senior physician at Raffles Medical, said tension headaches are usually caused by excessive muscle tension around the head and neck and self-medication with a painkiller should suffice.
When to see a doctor: If your headache is chronic, persistent or is unresolved despite the painkillers taken, you should see a doctor immediately.
Self-treatment options: Dr See said that over-the-counter pain medication like paracetamol (Panadol) and ibuprofen (Nurofen or Advil) are generally safe for mild headaches and back pain if the patient is not allergic to them and does not take them for a long time. Patients with asthma should be aware that ibuprofen may worsen their asthmatic condition.
INSECT BITE
When to self-medicate: If the insect bite wound is small with little swelling or pain.
When to see a doctor: Ms Quek Zhi Yuan, a pharmacist at the department of pharmacy at National University Hospital, said you should see a doctor if an insect bite wound has become bigger, is inflamed, has become filled with pus, and if you have a fever.
An insect bite may even cause a severe reaction such as swelling of the eyes or breathing difficulties. In such cases, see a doctor immediately.
Self-treatment options: Antiseptic cream like Mopiko or Zambac.
BACK PAIN
When to self-medicate: If it is an occasional pain.
When to see a doctor: If the pain does not subside with a painkiller or persists.
Self-treatment options: Topical painkillers like Bengay, topical non-steroidal anti-inflammatory creams, gels or plasters or Panadol.
CHEST PAIN
When to self-medicate: Pain that is not exercise-related and lasts less than five to 10 minutes, recurrent chest pains that are not consistent in quality and which do not feel like a weight on the chest, pain that worsens with coughing or turning or pain that occurs after a large meal or when lying flat may be treated with muscle relaxants or non-steroidal anti-inflammatory cream.
When to see a doctor: Dr See said that a common cause of mild chest pain is inflammation of the muscles and soft tissue around the chest area.
He said: “The patient can try some painkillers but if there is no improvement after about a week, a doctor’s view should be sought.”
He added: “If one suffers from a severe chest pain, there may be a chance that it could be a heart ailment. This type of chest pain tends to be compressive and feels as though a heavy weight is placed upon the chest.
“The person may become breathless and the pain may radiate up his neck or down his arm. I’d advise an immediate visit to the doctor for such severe chest pains.”
Self-treatment options: For mild chest pains, you can try painkillers, muscle relaxants or non-steroidal anti-inflammatory cream.
By June Cheong
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