A Little Bit of Me

Just like every other Malaysian, I visit the private clinic more often than the government-provided Klinik Kesihatan for minor ailments. The service is faster (although not always) and the whole set-up of a private clinic is more welcoming. Of course, all these come with a price. A 5 minute consultation + take-home paracetamol, cough syrup, anti-congestion and antibiotic for minor fever usually cost around RM 40 in Shah Alam.

However, do private practices always provide the best treatment option or services for their customers? The aspect that I would like to comment on is the lacking of patient’s involvement in making treatment decisions in private clinics (despite the money I have paid for consultation fees). Have you had your say in choosing what treatment you want for your own illness?

Ok, so what is an informed shared decision?

Informed shared decision is the decision made by the patient with the doctor after the patient has considered all the treatment options available based on the information given by the doctor.

To make an informed decision, the doctor should guide the patient and discuss the options available. During the discussion, the patient should really be briefed on the options pros and cons (e.g. if it’s a medicine – the benefits and side effects), how long the treatment regime should last for, the cost of the treatment and finally, doctors should answer all the questions addressed by the patient. It is not easy to make such discussion without the doctor’s initiative. Although I am a pharmacist and I have some knowledge about diseases and treatments (of course, not as great as doctors), nonetheless I used to feel ‘overpowered’ by the doctor when I face them. So, here are some tips on how you can work out making an informed decision with your doctor:-

1. Be well-equipped with knowledge about your condition and the current treatment practices.
A website that uses terms that can be understood by most people is http://www.medicinenet.com/. You can also find out the established treatment options from the website.

2. Don’t be afraid to ask questions.
If you are worried that you might get disheartened by their negative attitude, take a family member or friend along because doctor will seem less intimidating with the support of family/friend.

3. Remember what you and doctor have discussed about.
You can do this by writing down the key points your doctor mentioned. And it is not wrong to say something like “Could you please run through what you said to me again so I can be sure I understand it?"

Now, you don't want this to happen to you right?

I see more and more antidepressants advertisements on websites nowadays; some of the common tagline used including “Not sure if it’s depression? Learn about the broad range of symptoms” or “Is it depression? Learn about the symptoms here”. By clicking on the link, you will usually be directed to the websites with a list of depression symptoms. The symptoms of depression are broad and can range from headaches, backache to the more serious ones like thoughts of death and suicide. Of course, this information is true and they are good to know, but they can also be misleading.

I think that this is a very negative way to tell normal people who are well that they may be having depression. Some of the websites ‘diagnose’ internet users by using a checklist of symptoms and can make them worry that they are having depression. Most of us experience some form of discomforts that are part of the symptoms of depression, but having some of the symptoms do not make you depressed. Some of the physical symptoms of depression are:-
Aches and pains – which is also caused by daily physical activities like carrying weights, long-hour standing and even typing continuously at work (Repetitive Stress Injury, RSI)
Change in appetite or weight –this is very common in females, especially before menstruation (weight gain due to water retention), or sometimes when it’s the festive season, we eat more so we gain weight
Fatigue or lack of energy – some of us work long hours and the nature of the work is physical activities like walking, driving or reading countless documents. It is completely normal to be exhausted by the end of the day

You see what I mean? The way these advertisements are made can be easily misinterpreted. As a matter of fact, I believe that they are made to make people believe that they are having depression to boost the antidepressants sales. We should bear in mind that these advertisements are from pharmaceutical companies, kaaching!!! (Money, money and more money!)

No supplement tablet can replicate the natural goodness of whole, fresh foods. The best way to achieve vitamins and minerals RDA is by ensuring that we eat variety types of food. Furthermore, most foods are now fortified with micronutrients, e.g. cereals. If you practice a well-balanced diet, there is no need for supplements. Mind you, they are not cheap!

However, if you do need supplements, once-daily multivitamins is the best choice. Formulas with only a single vitamin predispose one to overdose. You must also adhere to the dosage because they can be toxic (although unlikely) –overdose of vitamin E increases risk of stroke, excess beta-carotene may increase cancer risk, particularly in smokers (and give your skin a tinge of orange/yellow, like carrot!). Furthermore, taking too much water-soluble vitamins is a waste as they are excreted in your urine.

As a guideline, here is a table brief enough to take when you’re buying supplements: (http://ec.europa.eu/food/food/labellingnutrition/supplements/documents/denmark_annex2.pdf)

Micronutrient Upper Limit (maximum/day)

Folic acid 1000 microg
Vitamin B1 100 mg
Vitamin B2 40 mg
Vitamin B6 100 mg
Vitamin B12 2000 microg
Vitamin A 3000 microg
Vitamin C 2000 mg
Vitamin D 50 microg
Vitamin E 1000 mg
Calcium 2500 mg
Magnesium 350 mg
Iron 45 mg
Zinc 40 mg
Manganese 11 mg

Congratulation Kak Eju and husband on your newborn! She's so beautiful and weighs a healthy 3.21kg! Kak Eju had to undergo caesarean so I would like to share some tips on caring for incision:-

1. Keep the wound dry. It’s okay to shower several days after surgery (preferred to bathing), however ensure that the wound is carefully and thoroughly dried.
2. Watch for signs of infections e.g. puss formation, intense pain and redness, fever.
3. Avoid activities that are likely put pressure on incision. However, walking is encouraged as they help restore energy levels and digestive functions.
4. Drink plenty of fluid and nutritious food to help build tissue and heal wounds

108 number of words (Whoops!)

I find many Malaysians seem to neglect their medicines, i.e. not taking them accordingly or improperly. E.g. an antibiotic course of treatment must be finished, yet I always find antibiotic leftovers in the fridge. Many of my family members are asthmatic, but they do not use inhaler to prevent or control exacerbation. Medicines help controlling a disease, inappropriate use can cause:-

1. Recurrence of infections
2. Chronic conditions worsen and uncontrollable
3. Degeneration of body function
4. Increased side-effects
5. And above all, waste of money and efforts!