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December 13, 2013

Not Well? Do These Before You See a Doctor

Not feeling well? Before you go to the doctor, do these to avoid wrong treatments.

by Dyah Retno

Indonesian doctors went on strike early this month, protesting the detention of three fellow doctors in Manado who were accused of malpractice. The strike raised yet again concerns over health services and patient safety in Indonesia.
While we can't really do anything with how health services being run, as consumers we can do something to avoid, if not minimize, overtreatment or under-treatment by doctors. Below are tips on how to make sure you get the right diagnosis from your doctors.
1. Observation and home-treatment:
Don't rush to the hospital when you experience the first onset of fever or runny nose. When there is no emergency situation, it's best to observe at home. Most common health problems such as common cold and diarrhea are self-limiting diseases caused by virus, meaning it will heal itself over time. You’ll be surprised by how we often pay hundreds of thousands rupiah to buy drugs that we don't really need to treat runny nose and diarhea.
The rule of thumb for home observation is 72 hours. But in an emergency situation, this rule won't apply. Emergency situations include:

- Fever that runs more than 38 degrees Celcius on babies younger than three months old
- Severe dehydration (not urinating for 6-8 hours for babies)
- Projectile vomit that isn't caused by eating or drinking
- Frequent vomiting and bowel movement in the last 12 hours
- Lethargy
- Breathing difficulties 
- Drowsiness
- Poor feeding in babies
Note: You can have fever of more than 38 degrees Celcius, headache, runny nose and an appetite loss, but if you can still name correctly the family member of Kardashians, it's definitely not an emergency.
2. What to do during home observation:
- Take note of your or your child’s body temperature, fever pattern (typhoid fever, dengue fever and common cold fever each has different pattern), vomit frequency, bowel movement (how many times in the last 12 hours; what is the consistency and color, or if there's any blood in your stool). Write them down. These notes will be very helpful when you go to the doctor to help them make better diagnosis.
- Treat symptoms according to guidelines. For example, If you have fever or diarrhea, drink a lot of water or oral rehydration solution to prevent dehydration. Soaking in warm bath or taking warm shower can help ease fever. There are many websites that give easy-to-understand guidelines on how to treat symptoms such as fever, diarrhea, cough, runny nose or headache. My favorites are www.mayoclinic.com, American Association of Paediatric’s www.aap.com, and kidshealth.com, or in Indonesian www.milissehat.com.
- Observe behaviors such as eating habit, physical activities and appearance for signs of emergency. Are there any symptoms aside from fever such as runny nose, cough or rashes?
- Make time to browse the Internet about your possible health problems.  Mayoclinic has a superb symptom checker. You simply input the symptoms and the website will come up with a list of possible illnesses 
1. Bring in all the notes and print out for discussion with your doctor. Remember, the aim of seeing your doctor is not to get drug prescriptions but to get a diagnosis. According to World Health Organization, drug therapy is just 1 out of 5 therapies to treat an illness
2. Ask the doctor these three questions: 
            - What health problems are you having and what caused it?
            - What do you have to do?
            - What you should be aware of and when to contact doctor
3. Ask your doctor to give diagnosis in medical term. Instead of just saying you're having a sore throat, your doctor should say either it is pharyngitis, laryngitis or tonsilitis. It should be gastroenteritis instead of stomach flu. 
4. When you have the diagnosis, take time to browse the net to find out details of the illness including causes and treatment. Now is a good time to put your intelligent phone to good use for browsing the symptoms of your health problems.
5. Ask your doctor to write clearly the prescription and ask him/her to explain:
    - How to take the drugs
    - Active substance contain in the medicine, how does it work?
    - Are there any side effects? And ask if the drugs have cheaper, generic version
    - If you're taking other medications, let your doctor know and ask him if the prescription that s/he gives won't interact with the ones you are taking
6. Also, ask if there's other type of therapies other than drugs.
7. As a patient, you're also entitled to have second opinion
1. Ask your doctor to write the prescription clearly. Count the line of drugs in the prescription. If you're having more than 3 lines, it is polypharmacy
2. If there's no life-threatening situation, again, take time to browse the drugs in the prescription before you buy them. My favorite website for checking drugs is www.drugs.com. I simply key in the active substance contained in the drug and see if it matches the doctor’s diagnosis.
A pediatrician once prescribed my son phenobarbitol, which is used to treat epileptic patients, for his swollen lips after falling from a slide. It wasn’t immediately noticeable because phenobarbitol was crushed with other drugs in compound drugs or known as Puyer. I happened to notice it  because the prescription was printed out, instead of in the usual doctor's hand written note. It was dangerous because, firstly, my son is not epileptic and, secondly, swollen lips are treated by keeping it clean and applying it with cold compress. 
1. Become informed about common health problems. It's not rocket science. Basically you only need to learn about these health problems: fever, vomit, diarrhea, cough and common cold as well as antibiotic. It's the age of information glut.
2, Choose reliable health websites to learn about health problems. Again, my favorite is www.mayoclinic.com because it is concise and doesn't overwhelm readers with medical jargons. WHO also has a good website. Locally, Yayasan Orang Tua Peduli or Caring Parents Foundation has a good website in Indonesian to learn about common health problems.
3. Most importantly, take time to learn about how to handle emergency situation. Knowing about emergency situation will help you not to panic easily. 
Source: Training material from Pesat Seminar, held by Yayasan Orang Tua Peduli 
About Dyah Retno
Dyah is a mother of one son who lives in Tangerang. She is actively campaigning for the rational use of medicines.