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Be rational … please!

by Dra Maria Alice [email protected]

Dr Maria Alice is a consultant in General and Family Medicine and is director of Luzdoc International Medical Service in Praia da Luz, Lagos.

We, human beings, are supposed to be rational, remember? The rational animals, the difference between Man and “other animals”, and all that … in short, our fantastic superiority: rationality!

Isn’t it wonderful? We are rational and that makes other animals nothing more than … irrational.

Yes, it is wonderful, we are the clever ones, the best ones – but are we? Or we may not be as, indeed, we behave many times in a completely irrational way, forgetting to use our “special tool”.    

Thus, more often than we would like, patients and – I have to confess – sometimes doctors and other health professionals are a bit – how can I say this? – not so rational when using medicines.  

Rational use of medicines requires that “patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community”.

A major global problem

Irrational use of medicines is a major problem worldwide. The World Health Organisation (WHO) estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines result in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include:

• Use of too many medicines per patient, “poly-pharmacy”

• Inappropriate use of antimicrobials (antibiotics) for non-bacterial infections often in inadequate dosage.

• Over-use of injections when oral formulations would be more appropriate

• Failure to prescribe in accordance with clinical guidelines

• Inappropriate self-medication, often of prescription-only medicines

• Non-adherence to dosing regimes


The WHO defines self-care as “what people do by themselves to keep their health, prevent and treat illness”.

Self-medication is the selection and use of medicines chosen by the patient for the treatment of an illness or the treatment of symptoms that the patient has perceived by themselves.

In this sense, it is a part of self-care activities as hygiene, nutrition, lifestyle and is influenced by socioeconomic and environmental factors.

Responsible self-medication implies that the patient treats his/her illness or symptoms with medicines available without prescription, which are safe and effective when used according to the established conditions. It is therefore a legal activity but it needs qualified and independent information in order to make a good decision.

Special care should be taken with vulnerable groups such as children, the elderly and pregnant women, who should not take medicines without medical prescription.

Responsible self-medication does not intend to leave aside the strategic role belonging solely to the doctor and so the contact with the patient should not disappear.

Responsible self-medication demands the following:

1. Medicines of proven safety, quality and efficacy

2. Medicines indicated for conditions that can by recognised by the patient himself/herself or for some chronic or recurrent situations which have been previously diagnosed by a physician.

3. Correct information describing:

• How to use it

• Possible effects and side-effects

• How to monitor the medicine’s efficacy

• Possible interactions

• Precautions and warnings

• Treatment duration

• Point at which the patient should seek medical advice

If a person decides to take a medicine without consulting with a physician, they should be able to:

• Recognise the symptoms to be treated

• Determine that their health condition allows for self-medication.

• Choose the correct medication for their symptoms

• Follow the instructions included in the labeling and those provided by the pharmacist over the counter.


Self-prescription is defined as the intention of purchasing prescription medicines without a prescription. And, believe me, this intention turns many times into action, unfortunately.

Responsible self-medication implies the use of medicines which do not require a prescription, as opposed to self-prescription, meaning the indiscriminate use of prescription medicines without an indication or professional supervision.

Promotion, marketing and advertising of medicines should be clear, precise and show risk-benefit relationship. This should be done in a way that should not encourage irresponsible self-medication and the purchase of unnecessary medicines or of excessive amounts. This is how it should be and many times it is, but, even when it is, do people always “read” it properly and rationally?

Information and health education can help to ensure responsible and positive self-medication as well as to prevent undesirable and dangerous self prescription. This is where the work of health professionals, including the pharmacists, is of extreme importance.

The pharmacist’s role is a key element to help customers to make the best decision on self-care and responsible self-medication, as well as to provide and interpret the available information about medicinal products and, most important of all, to make the customer/patient understand (which is not always easy) that although they have it in the shop, a doctor must be consulted and prescribe so that they can legally sell whatever the customer might need of prescription medicines.

It might be cheaper and quicker not to see the doctor and just self prescribe but it might end up being “deadly expensive”.

Reliable health professionals’ advice and country laws should be obtained and followed whenever medication is taken.  

Rationally that is how things are and how they really should be.

Final note: Do not use, ever, left-over medications from your bathroom cabinet without being sure, beyond any doubt, of what they are!

Best healthy wishes,

Dr. Maria Alice

Consultant in General and Family Medicine. General and Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve.

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