💊 Rampant use of high doses of steroids is leading to uncontrolled blood sugar levels in many patients, suppressing their immune system, and encouraging this fungus called mucor to grow unchecked!
🤔 But is steroid overuse really the root cause?
🙈 Why should there be rampant use of high doses of steroids, with no monitoring of blood sugar levels?
🥵 Some of it may be attributable to the panicked patients and overworked doctors. However, there are deeper underlying causes why patients and doctors have been so deeply affected by this malady.
I see three causes:
☝🏼 First, for many doctors and patients, the main purpose of a consultation has become just to generate a prescription for medicines, unfortunately. 📝
🔮 Everyone is looking for a magic cure for this scary disease, and doctors are also prescribing cocktails of medicines with unproven benefit, just in case something may work to reduce the chances of ICU admission and death.
🤏🏼 Whereas, the role of medicines in any disease is minor compared to supportive treatment, especially in viral illnesses.
🌏 After 1.5 years of the whole world looking for a ‘cure’ for COVID-19, we’re back to the basics: most medicines don’t work, or have very limited window in which they may provide minor benefit, and most patients only need supportive treatment.
💪🏽 However, it takes much more than a few words written on a piece of paper to provide supportive care, and to manage the main symptom of this disease: fear.
🤗 This needs honest admission on part of the doctors that we don’t have a magic remedy to treat COVID or to prevent complications. This needs culturally sensitive discussion on the value of home remedies and OTC medicines for symptom relief, and most of all, a confident assertion on the part of the doctor that this is all that is needed.
😤 Oral steroids have some role in patients whose SpO2 is falling below 94%, and no role at all in patients with normal SpO2. More than 90% of all COVID patients have normal SpO2, and therefore don’t need steroids. On the other hand, steroids can actually lead to increased anxiety, and worsen the paramount symptom of fear!
✌🏼 Secondly, online platforms and social media are making it super easy to copy-paste prescriptions. 📲
🖥️ Doctors use this feature to reduce the time needed to create prescriptions, and that’s good. The problem arises when this feature is overused and the ‘standard’ cocktail of medicines is prescribed to all COVID patients, regardless of their severity or symptoms.
🤲🏼 And patients freely forward such prescriptions to friends and family. After all, if the purpose of a consultation is to generate a prescription, then why go through a consultation when you have a ready-made prescription in your mobile. Many such prescriptions contain oral steroids, and a large number of people are ending up taking steroids without realising the side-effects or the importance of close monitoring while taking steroids.
🤠 Whereas, a quality consultation always results in a personalised prescription. Only those medicines which are needed to provide symptom relief to this particular patient, judicious use of inhaled steroids, and very judicious use of oral steroids. A lot of things need to be considered before prescribing oral steroids, and most of these patients are sick enough to need hospital admission.
🤟🏼 Thirdly, health care is becoming more and more transactional because of the above two reasons, and there’s less and less value being placed on the doctor-patient relationship. 🤝🏽
🥸 A Consultation is often a single interaction between two strangers, who might never interact again.
😒 This leads to dissatisfied patients as well as burnt out doctors. And dissatisfied patients start shopping around, consulting multiple doctors, ‘collecting prescriptions’ from various sources, and often end up under-treating or over-treating themselves. There’s always a danger that they may take multiple brand names of the same medication, leading to toxicity. We see that very often with Vitamin D supplements.
🦠 And that’s where mucor thrives: in patients prescribed oral or IV steroids, but with no monitoring of sugar levels, and no follow up with the treating doctor.
😇 Conversely, if there’s trust between the doctor and the patient, and close followup of all COVID patients for 10-15 days from start of symptoms, then two things happen: one, ‘just-in-case’ steroid prescriptions can be minimized, as both parties are confident with each other, and certain that they will continue interacting with each other. And two, the sugar levels of patients started on steroids can be monitored regularly, and corrective action taken early if sugar levels increase.
🧘🏻♀️ Such trust can be easily built through a relaxed consultation, with space for the patient to tell the story in their own words, and the openness on the part of the doctor to address the concerns of the patient and the family, and to modify the prescription based on the unique circumstances of this particular patient.
🔭 And so, dear doctors, lets redesign our practices and protocols for long-term care. If we can do so for COVID patients, many other patients will benefit as well, including those with TB, Dengue, allergies, Asthma, Hypertension, Diabetes, etc. Let’s show the same eagerness in abandoning unproven therapies, as we show in adopting promising ones. Let’s do everything we can to win the trust of our patients, and continue a long-term relationship with them
👩🏻⚕️👨🏾⚕️ Dear patients, find a doctor who you can trust, and stick to them. Check your Temperature and SpO2 (and sugar levels if taking steroids) and send them regularly over chat to your doctor. Resist the temptation to use tablets to treat the fear of this disease – there are much more potent medicines available for that – talking to family and friends, practicing pranayam or meditation, and most of all, laughter!
✋🏻 And please, dear pharmacists, please act as guardians and stop dispensing dangerous drugs like steroids without a proper prescription in the patient’s name.
📉 Once we do this, mucor will be left to a footnote in medical textbooks, something we will use to scare our grandchildren while telling stories over campfire.. 🔥