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Many bags of medicines

I had the privilege to be consulted by a middle aged lady today who came with three big polybags of
medicines. She had been consulting doctors at a secondary teaching hospital in Delhi from three
different departments: neurology, psychiatry and orthopedics (Apart from internal medicine

She had counted the number of tablets she would take every day and informed me that she was on 24
tablets, morning and 24 at night. Indeed, she had multiple comorbidities, Parkinson’s disease, diabetes,
hypertension, and depression along with lumbo sacral pain but the helpful doctors had prescribed her
medicines right left and center and had not been able to look at the medicines that she was getting from
the other specialties. As a result, she was taking amitriptyline 25 milligrams FOUR tablets a day! She had
been prescribed amitriptyline 25 once a night by the psychiatrist, twice in the day by the neurologist and
once in the morning by the orthopedician! She was also on clonazepam 0.25 two tablets twice a day,
having been prescribed dually by the neurologists and orthopedician! Then there was duloxetine which
had been prescribed by the neurologist twice a day, as well as the orthopedician once a day.

Due to the large burden of medicines she was actually not taking the adequate dose of antidepressants
which had been prescribed to her by her psychiatrist. She was supposed to take sertraline 200
milligrams a day but was actually taking only 50 mg a day. And yes I forgot about the multivitamin multi
mineral antioxidant costly placebo supplements that had been prescribed by the neurologists and the
orthopedic surgeon as a result of which she had about four different such placebos.

I carefully perused through her prescriptions, the bag of medicines that she had bought and was able to
reduce at least some pill burden by separating the chaff from the wheat, by separating those that were
either duplicate or unnecessary. I then reassured her that further reduction was possible as she got
better and that even if she did not get any better, we will try and find medicines which will not increase
the number of pills per day but still would help her.

Unsurprisingly, she was not very aware of her medical condition or how to take care of her illnesses
and least of all of how to navigate through the public sector health system. Her husband, who was a
government servant was able to identify some of the medicines that she was supposed to take but
wasn’t able to take full responsibility of whether she was taking them or not.

After some cajoling, nudging, informing and educating the couple, they agreed that the husband would
set up separate packs of medicines to be taken in the morning and those to be taken at night, apart
from medicines to treat Parkinson’s Disease which are taken four or three times a day. The aim was to
make things a little easier for the patient herself to take appropriate medicines at appropriate times.

Secondly, I offered to look at the prescription and the medicines, which they would be getting from the
government hospital after their next visit with the neurologist, psychiatrist and orthopedic surgeon.

I hope that I was able to help her in some way. This role would have been better suited to a family
physician or the pharmacist who was dispensing the medicines at the government hospital or perhaps
even a nursing staff in the OPD. Such services at our government hospitals are needed more and more
especially with patients who have depression and/or who have multiple illnesses and who visit multiple
doctors and unfortunately who are faced with the prospect of different doctors, each time they visit a
government hospital. The lack of funding of our public sector health system has been an ongoing
degradation in our country for the last many decades. The result is that while our doctors are one of the
best in the world and much sought after in the private sector. Yet our own citizens are unable to benefit
fully from this abundant medical skill that our country possesses because of a lack of patient centric
systems, both in the public and private sector.

I wonder when and if there will be a time when the public sector health systems will be focused on
helping people rather than just dishing out unnecessary, facile gestures of cheaper medicines and free
OPD at hospitals which have been built at extremely high costs but which are inefficient use of scarce
health budgets.

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