KUALA LUMPUR, Aug 23 ― Self-medicating for serious illnesses is imprecise and dangerous, several doctors said after Malay Mail Online reported that some Malaysians have stopped seeking hospital treatment due to the lengthy wait.
Oncologist Datuk Dr Mohamed Ibrahim A. Wahid related a case of a 30-something woman in Kota Kinabalu, Sabah diagnosed with Stage Four breast cancer, who refused to see a doctor but bought oral chemotherapy drugs from a pharmacy instead and followed her friend’s dosage.
“We don’t know how many patients will suffer complications or side effects as a result of people buying drugs over the counter. And these are dangerous drugs,” Dr Mohamed Ibrahim told Malay Mail Online.
“Ministry of Health says you can’t buy antibiotics without proper prescriptions, but extremely dangerous drugs that can kill you can be bought over the counter in pharmacies without proper prescription and documentation, and we don’t know or not if patients are being supervised.”
The former Malaysian Oncological Society president claimed that chemotherapy and targeted therapy drugs for cancer were being sold over the counter in some small retail pharmacies without doctors’ prescriptions.
Earlier this week, Malay Mail Online reported 20 per cent of respondents to our online survey disclosing that they do not seek medical treatment at all or rely on alternative medicine.
In the survey that ran from August 16-18 and received 358 responses, just over a quarter cited excessive waiting time as the reason they stopped seeking medical treatment at public clinics or hospitals in the last 12 months. About 40 per cent said they waited four hours on average to see a doctor at government facilities in the last 12 months.
The report revealed that patients were not just switching from private to public hospitals amid high medical fees ― with the Association of Private Hospitals of Malaysia reporting a 30 per cent drop in the number of patients at private hospitals ― but that some people were dropping out of the healthcare system entirely. However, it is unclear just how pervasive the problem is in the country.
A man in his 20s who said he suffers from chronic spinal and nerve injuries shared that he would research on the internet and then buy medicines at a pharmacy.
Former Malaysian Medical Association president Dr Milton Lum said those who do not want to go to public hospitals because of long waiting times faced greater risk from whatever health conditions they had, such as high blood pressure or diabetes.
“The public healthcare system is being stretched. At some point in time, when you stretch anything, it'll reach a tipping or breaking point,” he told Malay Mail Online.
He said there were some benefits to self-medication, such as reduced government health expenditure for minor health conditions, but also highlighted risks like incorrect self-diagnosis, choice of treatment and drug dosage, as well as dangerous drug interactions and masking of severe disease.
“At no time should anyone with a chronic disease stop treatment without medical advice,” he said.
Relieving burden on public hospitals
National Kidney Foundation chairman Datuk Dr Zaki Morad Mohd Zaher suggested that Malaysia use nurse-led services to reduce patients’ frequency of visiting the doctor in cases of stable chronic diseases like high blood pressure, diabetes or high cholesterol.
The doctor can draw up the treatment plan, but nurses can monitor the patient’s condition through phone calls, email or text messaging, so that the patient only needs to see the doctor at the hospital once every six months or a year. The patient can purchase equipment measuring blood pressure and blood sugar for use at home and communicate with the nurse.
“So that will help reduce the crowd at hospitals, but it only applies to stable chronic diseases,” Dr Zaki Morad said.
He said nurse-led services have been practised in Scandinavian and European countries.
Dr Mohamed Ibrahim suggested that the Health Ministry collaborate with some general practitioners in the community to mitigate the burden on public hospitals, while Dr Lum said the ministry could purchase services from private clinics.
Health researcher Dr Lim Teck Onn said the solution to the increasing burden on public hospitals was to break up the public monopoly of healthcare in the country.
“Break up the monopoly such as was done to the dialysis sector 20 years ago. Nobody waits long to get into dialysis anymore,” Dr Lim told Malay Mail Online.
He noted that the dialysis sector was liberalised and patients were free to choose their providers, with the pooled reimbursement following wherever they sought care. The shift of the treatment for kidney disease to the private sector not just expanded healthcare access, but prices were kept low through competition, he said.
“Public hospitals should run on their own and have full autonomy,” he said, adding that those facilities should face competition too and be held accountable for their performance and cost.
Klang MP Charles Santiago from the DAP said he has heard of cases of people waiting three to four hours in an emergency case in public hospitals.
“The best way to describe the situation is that the urban hospitals are at a breaking point,” Charles told Malay Mail Online.
The federal Opposition lawmaker said most Malaysians did not seem to take their health seriously until they fell sick, by which time they would be in their 30s or 40s.
“What we need is health awareness in schools and hospitals. We need a healthy lifestyle which is becoming alien to most Malaysians. The Ministry of Health and the Ministry of Education need to focus on healthy lifestyles and preventive measures as part of its mandate,” he added.