Saturday, 4 April 2015


About 99% of people who come to the hospital with complaints expect a treatment in the form of prescription of drugs. They are not wrong by expecting this, especially in a private hospital setting in Nigeria where the management is mostly geared towards making profit than patient wellbeing. (Humans and generally selfish – the “me first” syndrome). Talking about drugs and dosage, see how consultations with 3 different patients play out.

First, a man comes into my consulting room, I establish a rapport and proceed to get his complaints. Then, I examine the patient, make a diagnosis, explain to him what the problem is, what caused it, how the illness with progress, what will happen if he doesn’t take his medications as prescribed. He thanks me and goes on to the pharmacy to get his drugs.

Second patient comes in, she’s a woman, looking anxious. Her symptoms are what we call non-specific symptoms, like something is moving around her body like a worm, her body is hot inside, (not a known peptic ulcer disease patient and not even close to her menopause). The symptoms go on and on. At a point, I had to stop her to be able to get somewhere. I decided to dig into the family and social history. She is married and has kids, (big issue in Nigeria). She has a good job and no problems with her spouse or any family member. I was about to refer her when something struck me to ask more about her financial status. As it happened, she just cleared her account to support her husband in building their new home. She had developed some anxiety knowing that her bank account was on RED alert at the moment. Finally, I counseled her and when I told her the consultation was over and she should have a nice day, she asked “No drugs?” she went home smiling.

The third patient typically makes up about ¾ of the kind of cases I see everyday. First of all, many Nigerians are illiterate and ignorant. This makes a lot of people gullible. The fact that they don’t know much of what you are trying to explain during the consultation makes it far worse. They take half of the truth you’ve said, mix it with their ideas and beliefs and transmit it to as many people (friends and family members) willing to listen in a very convincing manner. Almost every patient I see, have had some form of treatment for an illness they thought they were treating before they come to me. This problem is caused by the fact that;
  • Nigeria is a malaria endemic country and every fever is malaria until proven otherwise.
  • Everyone has a relative who is ready to prescribe something that they believe had worked for them (native or orthodox) and believe will work for everyone. The problem with these prescriptions is that they are often either wrong (medicine or dosage) or dangerous.

So, back to my patient, she walks in and tells me that she has been treating herself for malaria and somehow how it’s not working. Further evaluation revealed that she had been on amoxil for a few days, taken twice a day. So, she was on the wrong DRUG, (antibiotic instead of antimalarial) and to top it off, she was on the wrong DOSAGE with respect to frequency and quantity (twice a day instead of three times a day).

With that, I say welcome to my world!


  1. So Dr. Keren it seems that you are fighting on two fronts. In the first case you have an administration that prefers that you prescribe. While 75% of patients will have already begun to self-medicate incorrectly. What I conclude is they should be glad that you are part of the equation or the cost of pharmaceutical intervention would be through the roof. In the U.S. you can't access certain drugs without a doctor's prescription. The pharmacist in America can only sell what they call over the counter (OTC's) medications without a prescription. Furthermore it's illegal to share medication with a person to whom it wasn't prescribed. It's different in different countries, but perhaps we should look into restricting access to prescription medication in Nigeria a bit harsher than we do.

    1. I hope we get to the point in this country where chemists (not pharmacist sef) will stop prescribing medications for the populace. They are just a menace


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