Medication pic n mix?

(taken from Pulse magazine blog)

We have a number of non-English speaking patients and I’m not sure I’m really getting through to them about concordance with their medication. I’ve had several patients who happily take a prescription for their illness, then travel abroad and see a ‘doctor’ who gives them a variety of potentially dangerous treatments. They then pop back a month or two later and see me and complain they are not better, having stopped the original treatment and tried something else entirely. I’ve seen patients who have been given methotrexate, psoralins, roaccutane and a wide variety of topical super potent steroids without any supervision or monitoring whatsoever.

Do I decline to see them again until they do as they are told? What if they continue taking these treatments without any monitoring? Worse still, what if they give these treatments to their friends or children? I’ve had patients accuse me of being tight-fisted for not giving them the incorrect and dangerous treatment they have got from abroad. Warnings about potential serious side-effects fall on deaf ears.

It does make me wonder why they bothered seeing me in the first place if they won’t use what I gave them, but try some dodgy pills from a person with dubious qualifications. It is quite frightening what odd treatments patients can get hold off via a variety of means. Any time a patient sees me claiming a ‘special cream’ has cured them of their eczema or psoriasis I can be fairly confident the mystery ingredient is dermovate.

It’d be interesting to know how many patients use their medication for something other than what it’s prescribed for. I know of some elderly patients who have been sharing their medication, god knows what sort of interactions have been going on. I wonder if it’s a bit like pic 'n' mix?