I have a 46 year old man, who came for his annual blood check because he has underlying ischaemic heart disease, diabetes melitus, dyslipidaemia, hypertension and gouty arthritis. On his first visit, he did not have his list of medications with him. So I told him to come back the next day with his medications. He did come back the next day, with this list:
- T. Metformin 1000mg TDS
- T. Januvia (Sitagliptin) 50mg OD
- T. Amaryl (Glimepiride) 2mg OD
- T. Micardis Plus (Telmisartan / Thiazide) 80/12.5mg OD
- T. Concor (Bisoprolol) 5mg OD
- T. Norvasc (Amlodipine) 5mg OD
- T. Zocor (Simvastatin) 20mg ON
- T. Aspirin 100mg OD
- T. Allupurinol 300mg OD
Based on his latest blood results, his uric acid levels were normal, his sugar was well controlled, had microalbuminuria and BP readings were around 110-130 / 70-80 mmHg.
Now, what is wrong with the list? One thing for sure, just by looking at it, you know that he spends an awful lot of money each month just for these. He told me that he spends an estimated of 500-600 bucks each month. The second question that comes into mind was, “What’s he working as?”. Wouldn’t you be curious too? Guess what? He sells pork. That’s right. He’s a butcher who sells pork. Either he’s really a successful butcher, who earns tons of money each month, or someone is sucking this poor man’s pockets dry. Mind you, with that amount of money each month, you can pay for a car installment.
The second problem, he has gouty arthritis. Why would you start someone on a Thiazide when he has attacks regularly? And then you counter the gout with Allupurinol. This does not even make any sense.
Third, does he really need all those anti-hypertensives? He’s basically taking all 4 groups. It’s not like his blood pressure is that bad that he needs all 4 of them.
When you stop and ponder, you really do wonder why this is happening. Is this really about the money? Or was it really for the patient’s benefit. You be the judge.
To all budding and new doctors out there, do not be like a cyst.
A cyst is an anechoic lesion with no internal echoes present. All dark and gloomy. Please do NOT be like that. Be compassionate. Think of your patients. Rather than treating them with the most expensive drugs out there, treat them with the appropriate drugs instead, what’s best (expensive does not mean it’s the best) for him or her. And by doing so, would definitely give you a sense of satisfaction, and happiness too.