Popping Pills

Yesterday a man in his 60's came to see me with knee pain. He had a diagnosis of osteoarthritis, or in other words, wear and tear of his joints. He knew that the condition could only be treated symptomatically. He knew that there was no way of reversing the process and no real cure apart from replacing the joint. He had always refused, however, to take any painkillers, claiming that he believed in the body's innate ability to heal itself. Now he wanted a referral to the surgeons for joint replacement.

It struck me as really odd that this man would prefer surgery to taking tablets, but he's not alone. There seems to be an ever increasing proportion of patients who don't like the idea of taking medication. Whilst they're often happy to consume vast quantities of echinacea, arnica and all number of unknown 'supplements', be poked and prodded by tiny needles or pay a fortune to be put into a trance, the idea of taking conventional medicine is akin to ingesting poison.

Despite what you may be thinking, I am not a pill pusher. Indeed I am completely in favour of taking as few medications as possible, as infrequently as possible. Nonetheless I do find it hard to understand this deep mistrust of conventional medicine. Why do so many believe in therapies which often have little scientific basis and almost always no real evidence behind them, whilst those treatments tried and tested under the most rigorous conditions are somehow feared.

There is also a belief, I think, that conventional or 'Western' medicine is in some way unnatural when compared to the complimentary therapies. A feeling that the medications are artificial and as a result could damage the body. Yet huge numbers of our most commonly used medicines are sourced from natural products: penicillin from a fungus, morphine from poppies, digoxin from the foxglove, aspirin from the bark of a willow tree.

So what's the big problem with conventional medicine?

The Volcano Effect

A New Kind of GP has spoken already about the bizarre events of last week and the questions that they have provoked. Did the government overreact? (...did someone mention swine flu?...) Are the airlines more interested in wealth than welfare? Can we be sure that it is safe to fly now? No doubt we will continue to debate these questions for many days to come. But there is another question that the now infamous Icelandic Volcano has raised in my surgery, and that is this; how far should we trust our patients?

It's not an obvious follow on from the problems of spewed lava and ash, I realise, but let me explain why this dilemma has arisen. My practice is in central London, surrounded by hotels. Given their unexpected holiday extension, foreign travellers have been drifting in in their masses, requesting extra medications. In amongst the hayfever pills, tablets for prostate trouble and antihypertensives, I have also prescribed hypnotics and antidepressants to patients I have never met before and am unlikely to see again. Is this OK? Would the GMC approve?

It's not actually just mid natural disaster that this predicament shows itself. How often do we have patients requesting repeat medications because they have lost their last prescription, or left their pills in Malaga? Other more bizarre stories I have heard are; "The dog ate them", "Someone stole them", "I fed them to the pigeons" (yes, I made that one up, but I wouldn't be surprised). Clearly how worried I get does depend enormously on what I am being asked for, but if it's anything that could be dangerous in overdose (most things) or could be sold down a dark alleyway, I do start getting a little nervous. Unfortunately challenging the patient rarely seems like great option either, since you still may not get the truth and you risk a breakdown in your relationship, something which no GP takes lightly.

So what's the answer I wonder? Is it safe to dish out pills to whoever pops in requesting some? Is it reasonable to give extra medication to a patient based on your gut feeling of their credibility?

Are any more Icelandic volcanos likely to erupt?