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Experts say mending thyself might not be good doctoring

POSTED: March 8, 2009 11:03 p.m.
SCOTT ROGERS /The Times

Callie Mae Cain browses through the medication aisle at Medical Park Pharmacy while she waits to see the pharmacist Friday afternoon. In a recent Kaiser Family Foundation survey, 53 percent of those asked said they have cut back on medical care in the past year because of cost. More than one-third said they were relying on over-the-counter drugs or home remedies instead of going to a doctor.

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Is "do-it-yourself" an effective strategy for health care?

Probably not, but after losing their jobs and insurance, many people feel they have no choice but to treat their medical problems at home.

In a recent survey conducted by the Kaiser Family Foundation, 53 percent of Americans said they’ve cut back on medical care in the past year because of the cost. More than one-third said they were relying on over-the-counter drugs or home remedies instead of seeing a doctor.

Twenty-one percent said they had decided not to fill a prescription, and 15 percent said they’re cutting pills in half or skipping doses to make the medication last longer. Sixteen percent said they’ve cancelled a doctor’s visit or postponed surgery.

In Gainesville, local doctors and pharmacists say they’ve noticed this trend.

"We’ve certainly seen people try to stretch out the time period between refills," said Laird Miller, owner of Medical Park Pharmacy.

But instead of saving money, this tactic may actually waste money by making the medication useless. If a drug is taken too infrequently or at a dosage that’s too low, it simply doesn’t work.

"If people maintain a blood level that’s below the therapeutic range, they’re not going to benefit from it," said Miller.

Also, when a person with a chronic illness skips doses of their medication, it can lead to wild fluctuations in their condition.

"It’s dangerous," said Miller. "It shouldn’t be done, especially if the patient has something like diabetes or heart disease."

When a person has a short-term, acute illness, such as a respiratory virus, over-the-counter medicines can sometimes be an acceptable treatment.

"You do see people buying OTC for colds and things like that instead of going to a doctor," said Miller. "Often they come in and describe their symptoms, and we can usually recommend something that’s probably almost as good as what they’d get from a prescription. But we tell them if they’re not better in a few days or they have a fever, they should contact their doctor."

But what if they don’t have a regular doctor?

"We’ve always seen people who are uninsured or underinsured and they’re trying to treat themselves," said Miller. "But there’s potential for abuse with OTC drugs because people have a tendency to take too much (since there’s no prescription to specify a dosage)."

The most worrisome risk of self-treatment is that patients may be guessing wrong about what disease they actually have.

"The worst-case scenario is a guy who keeps treating himself for diarrhea and he turns out to have colon cancer," said Miller.

Dr. Antonio Rios, an internal medicine physician with Northeast Georgia Health System, said people tend to assume that if they have symptoms similar to those of someone else they know, they must have the same illness.

Their next assumption is that they need the same treatment, which leads to an ill-advised sharing of medications.

"People are taking the unfinished prescriptions of relatives and friends," Rios said. "For the most part, they really don’t know what they’re taking or what they’re taking it for. Something bad is going to happen at some point, such as (drug) allergies or interactions with other medications. Plus, they may be delaying treatment for whatever their real problem is."

Dr. Philip Marler, an internal medicine physician with the Longstreet Clinic, said even when the economy is good, there are plenty of people who try to be their own doctor.

"When you get into an economy like this (recession), I see more people who are not coming into the office or they’re trying to get treated over the phone," he said.

When Marler knows a patient is struggling financially, he tries to be accommodating. "If possible, I recommend a cost-effective OTC treatment (over the phone)," he said.

But if the patient’s symptoms are potentially serious, there is no safe alternative but to come in to the doctor’s office. And people shouldn’t assume that because they have no insurance, they can’t afford to see a doctor.

"Talk to the doctor and explain your circumstances. See if you can work something out," said Marler. "Self-pay patients at Longstreet automatically get a 30 percent discount just for paying cash. And sometimes I’ll see an established patient for no charge. I don’t want someone with a chronic illness to go without treatment."

Delaying care may be penny-wise and pound-foolish, because the end result could be an astronomical hospital bill.

"If you let your blood pressure go out of control, you might be OK for a little while, but if it goes on for a year, you’re going to be deathly ill," said Marler.

The good news is that if you can scrape together enough cash for a doctor’s visit, your medicine might not cost as much as you think.

"Whoever came up with the idea for those $4 generic prescriptions at Wal-Mart ought to get a medal," said Marler. "That did more for people’s ability to take medicines than the Medicare Part D plan (a government insurance program for the elderly) did. It may not have the same variety (as the brand-name formulary), but for most chronic illnesses, you can usually find something that will work."

After Wal-Mart started offering $4 prescriptions on hundreds of generic drugs, several other national pharmacy chains adopted similar programs.

Rios said these plans have become very popular with patients.

"Everybody’s asking to be switched to the $4 generics," he said. "We’re really lucky to have that. It’s not the answer to everything, but it’s definitely been a blessing."

The inexpensive medicines have broadened access to health care, but Marler said more needs to be done so that everyone can afford to see a physician and not resort to self-treatment.

"I am not in favor of socialized medicine," he said. "But I really hope Congress and the Obama administration can establish some type of medical safety net for people who have no other way to get insurance coverage."



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