I am a really funny doctor.
Most of the time, while I'm giving prescriptions to my patients, I find myself asking if the medications I'm actually giving really do work. I wouldn't go as far as saying I doubt every medication I dole out, but I find myself skeptical most of the time.
Take for instance, cough medications. I've given my share of cough medications over the years I've had in medicine from internship to residency, and none of them seems to really stop the cough. Mucolytics, expectorants, antitussives, antihistamines ugghh, they seem to just not do the job. So, if asked what medication I'd want to give to patients having cough, on instinct, I'd say water. After all it still is the best mucolytic, in my opinion.
Well, it's different if you know the problem, say TB or Pneumonia, for which we can treat the cause of the problem. Antibiotics are great drugs. But again, there are stuff to consider like resistance, the bacteria you're up against on whether they're wearing Amoxicillin shields or Cephalosporin-proof vests. So you end up with just a grand old time figuring out what to give until the sensitivity testing comes out, that is if there are discs to use or microbes that grow on the cultures. Which is why most doctors start out with really broad spectrum antibiotics nowadays and work it down once the testing comes out.
Neuroprotective agents for strokes? Hmmm, skeptical, though theoretically sound.
Appetite stimulants? Nothing more appetizing than a well-cooked and seasoned meal.
Vitamins? A good diet is still the way to go, in my opinion. Vitamins will not save your liver if you keep on drinking alcohol or your lung if you keep on smoking. Most people think all they need are vitamins, asking for them left and right, and I make a face, but when all that's said and done, what they need is a healthy lifestyle, a healthy diet, a good dose of exercise and proper hygiene.
Don't get me wrong, I'm not trashing medications nor am I trashing my own profession. I love my job (though it's been often described as having a degree in knowing nothing) as we often get to save lives provided we get the right medications to the patient.
And there are drugs I believe in, after all, I'm still in Internal Medicine, say adenosine. I marvel and I hold my breath at the same time while watching that long, long, really long pause on the scope and gradual return to sinus after a supraventricular tachycardia. There are others like beta-blockers, epinephrine, norepinephrine, and a host of emergency drugs.
There still is good old Paracetamol, which when combined with a properly done tepid sponge bath brings down any fever in a matter of minutes. The nebulizations are pretty dramatic as well. Cardiac-wise, warfarin and aspirin have been pillars of the medical arsenal for a very very long time.
Medicines are really funny things. Some work. Some don't. Some you just can't see.
I guess that's why doctors are around to figure stuff out.
If we ever do. Hehe.
4 comments:
Amen jud ko, Bri. Medicines are amazing things. And water is best!
True!! And what to do when people come to you to ask for medication for a cough that did not get well afer a host of meds have been tried by other doctors??????? And there's always this awareness that if you give them something that doesn't work, they'll think bad of you. But when you give them nothing -- it's self-limiting, all you need is a healthy immune system, etc -- they'll think bad of you. It's hard living up to people's expectations hu hu hu. :-)
And yes, water water water.
Sometimes, even though we know that these medicines are placebo, we just have to give them because these are what will make our patients happy (and well, eventually). :)
There's also such a thing as Evidence Based Medicine, which also takes into account patient expectations. I agree with Merry Cherry. It's not just about meds - our patients (their psyches and their immune systems) are part of the healing process. We have to give 'medicine' for those too, even of some of them are called 'placebo'.
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