My experiences with Betnovate

Betnovate is a famous brand of topical steroid Betamethasone valerate.

Recently we saw many acne patients with monomorphic lesions ( all lesions have same morphology). This particular type of acne is frequently seen in patients who are on steroids, topical or oral. Over a period of time we have found Betnovate to be most common culprit. We were surprised by this rampant " cosmetic" use of betnovate and decided to find more. And man what we found!! People specially young guys and girls were using it to lighten the skin color. God!! thats hypopigmentation and thats a side effect. There are other side effects too like thinning of skin and permanent blood vessel dilatation( this will cause redness- people like Fair and redness combo), increased fragility of skin etc. People are using this cream to get "desired side effect" and are ignoring all other side effects.

I will narrate 2 incidents to highlight the issue of widespread cosmetic use of Betnovate. One incident involves a newly married woman. Apparently she started using Betnovate before her marriage. After marriage she shifted to her in-laws place and here Betnovate was not available. So soon her "fairness and redness" was gone. She attended hospital on her husband's insistence and asked for an alternative for Betnovate!! so that she can continue to look fairer. The other incident involves a medicine shop owner. One patient proudly narrates a story where how the local people threatened a medicine shop owner to keep a constant supply of Betnovate!

I am surprised to learn what marketing and promotion can do!! And, " intelligent"-among-local people have contributed their bit, i am sure of it.

Is there anything like P- diagnosis?

Before coming to my point i want to highlight the concept of P-drug that we read in pharmacology during our undergraduate days. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. This thing helps a physician to handle pharmacological concepts and drug-related data in an effective manner by developing one's own set of P-drugs. so instead of prescribing different drugs in same group, physician sticks to one particular drug from the group. This helps in better understanding of that particular drug.

While doing my post graduation i have got chance to sit with different teachers and learn from them. And over time i have realized one particular guy makes diagnosis from a list of say 50-200 conditions ( No. of entries in list depends on competency of that doctor... More entries..better Clinician!!) And interestingly this list differs for different clinicians. I have noticed that a certain diagnosis is made by a particular doctor only- other guys almost never make this particular diagnosis. This should not be a problem where a diagnostic tests is available. But this becomes an issue in dermatology where most of the conditions are diagnosed clinically. Diagnostic tests are either not confirmatory, not easily available or not affordable. So the problem!! Its confusing for beginners like us.

I have always believed one tends to follow one particular teacher while learning medicine. Medicine is not learned from the books, but from the teacher. Its like creating a intellectual clone- Both the doctor and the " intellectual cloning process'' can be good or bad. So our clinical acumen definitely depends on who we decide to follow. And this is where concept of "P- diagnosis" matters- at least to me. It helps me in deciding whose "intellectual clone" i wanna be!!

Nostalgia

Found it somewhere...sharing here with you guys

Gone are the days!!!My Friend..

When

The school reopened in June,

And we settled in our new desks and

benches!

When

we queued up in book depot,

And got our new books

and notes!

When

we wanted two Sundays and no Mondays, yet

managed to line up daily for the morning prayers.

We learnt writing with

slates and pencils, and

Progressed To fountain pens and ball pens and then Micro tips!

When

we had lunch in classrooms, corridors,

Playgrounds,under the trees and even in cycle sheds!

When

a single P.T. period in the week's Time Table,Was awaited more eagerly than the monsoons!

Gone are the days

Of Sports Day,

and the annual School Day ,

And the month long preparations for them.

Gone are the days

When we used to talk wid frends now we dont have time to say hi.

when we used to chat for hours now we chat in chat rooms.

gone r those days,but their memories will linger in my heart!!!

Life that matters.... is all about choices u make!

i didn't write it...read it somewhere... n liked it. sharing with u guys

Ready or not,

Some day it will all come to an end.
There will be no more sunrises, no minutes, hours or days.
It wont matter where you came from,
Or what side of the tracks you lived on at the end!
It wont matter whether you were beautiful or brilliant!!
Even your gender and skin colour will b irrelevant.

What will matter is not your success,
but your significance!
What will matter is not what you learned,
but what you taught!
What will matter is every act of integrity, compassion and courage.
What will matter is not your competence,
but your character!
What will matter is not how many people you knew,
but how many will feel a lasting loss when you are gone!!

Living a life that matters does not happen by accident !
Its not a matter of circumstance,
but of CHOICE!!

INFORMED CONSENT

Well its well known that Doctor-Patient relationship is undergoing hell lot of changes. But here i am writing on 1 facet only, ignoring other issues.

There is a growing trend towards getting INFORMED CONSENT regarding various medical procedures, separately for multiple procedures, from patients. I am not totally against it but i do think its not such a great idea.

In my experience, many patients will go for just the opposite i recommend. Like if i asked patient to get admitted for his/her condition, He/She refused. Or, if i did not advise admission they often make a request for admission. I think growing distrust on doctors is responsible for this. There are many a thing responsible for this growing distrust but i am not going into details as it itself is a big story. One thing that i would like to highlight here is- people has started thinking that they too knows "THINGS" which is contrary to the truth. Reading an article in 3-4 Rs. Newspaper or 50-100 Rs. magazines does not make you an expert (and it does not intend to!!!!!) but people choose to think otherwise. It definitely contributes to the problem.

Moreover making a decision is not that easy, specially when the situation is critical and you have little idea about "THINGS". And the severity of this indecisiveness is directly proportional to number of choices. It must be true for many guys. I feel it very often, even if it involves a simple thing like shopping for shirts or watch!! & this problem is more severe when i shop for something i know less about. I guess its universal. So how can we expect an injured person to make a best decision based on information a doctor provides?? Of course a doctor can not give a full power point presentation regarding the management every time he encounters a patient. And patient too wont be able to grasp every details.

Moreover i think it makes the Doctor- Patient relationship somewhat like a seller-buyer. Its like explaining merits and demerits of your product and letting him choose what he think is best. (not necessarily what is best for him). I guess it ruins the sanctity of Doctor- Patient relationship, making it seem like a pure business one.

I would rather prefer a situations where Doctors make decisions only in the best interest of a Patient (not their own- commercial ones, obviously) and Patients trust that wholeheartedly.

I must add this, even if i dont like it. The last decision should be patients's own. After all its Their Health only.

COMMENTS WELCOME