Pain Medication

[JonPalawan]

What experience do people have regarding pain medication? I think it's over prescribed.

I am 70 year old US citizen living in Palawan. Every time I have any procedure performed, be it dentistry, a troubling shoulder, or whatever, the doctor wants to prescribe pain medication to take home with me, which I decline. I'm not stoic, rather, my thinking is that pain has a reason, namely, telling me to stop doing what I'm doing. Of course, I'm talking about mild to moderate pain.

My helper's 22 year old brother recently fell and struck is head hard. He was taken to hospital, as his speech was slow and other symptoms. He never complained of pain, yet his doctor prescribed large doses of Ketesse, 200mg for each of his first two days of confinement, 150mg for the next two days, and 50mg for the fifth day, a total of 750mg over five days, billed at P11,340. The maximum recommended dose is 75mg per day. He had no muscular-skeletal pain, menstrual pain, tooth ache, or recent surgery, the four indicators for this medication. And all this in full knowledge that he had kidney issues. A contraindicator is kidney dysfunction. The doctor even threatened that dialysis might be necessary. I'm not a doctor, but I can to internet searches, and I opine that this was a gross overdosing of Ketesse.

[chris49]

I will not go over the pharmacology of Ketesse which is not the common name. Dexketoprofen, like Ibo Brufen, abut 4 pesos per tablet generic brands.

CT scan was done? I think yes.

So I throw the situation back to you. Why did you accept a 5 day hospitalization if the CT scan was clear? Obviously a private hospital because CT is generally not available in gov't hospitals.

Ibu brufen in low dose has a minimal risk of bleeding vs other pain relievers, so maybe that's why it was chosen. As for the fancy name, well he got you there, right?

Again back to you. The patient has no pain, why is he accepting pain meds? Very very remotely it could be linked onother reason eg coagulopathy, but I doubt that. It is not a major cause of inter cranial bleeding, but I would not take it anyway.

As for Rx written by Doctor's? Isn't that their job? It is really up to you if you go and buy it or not.

The bill you quote is about average for 5 days in a private hospital. If in gov't did he elect a private room and pay for it?

[JonPalawan]

I will not go over the pharmacology of Ketesse which is not the common name. Dexketoprofen, like Ibo Brufen, abut 4 pesos per tablet generic brands.

Yes, Dexketoprofen. Dose was 50mg amp, P756 a pop

CT scan was done? I think yes.

CT scan was clear.

So I throw the situation back to you. Why did you accept a 5 day hospitalization if the CT scan was clear? Obviously a private hospital because CT is generally not available in gov't hospitals.

Palawan Adventist. Patient was pretty much out of it. His parents felt they were in no position to question what was being done.

Ibu brufen in low dose has a minimal risk of bleeding vs other pain relievers, so maybe that's why it was chosen. As for the fancy name, well he got you there, right?

This was not by any stretch low dose. 200mg is 2-2/3 times the maximum dose, ergo my question: do doctors overdose pain medication here?. I don't understand "he got you there, right?" You are suggesting that we were tricked?

Again back to you. The patient has no pain, why is he accepting pain meds? Very very remotely it could be linked onother reason eg coagulopathy, but I doubt that. It is not a major cause of inter cranial bleeding, but I would not take it anyway.

Patient was pretty much out of it, and  passively accepted the treatment.

As for Rx written by Doctor's? Isn't that their job? It is really up to you if you go and buy it or not.

 Medication was administered by hospital personnel. We didn't know what he was receiving until I requested to see itemized bill.

The bill you quote is about average for 5 days in a private hospital. If in gov't did he elect a private room and pay for it?

You misunderstood, P11,340 was for that medication only, 15 amps at P756 a pop.

Edited August 21, 2015 by JonPalawan

[Tukaram (Tim)]

I just wish they had some decent pain meds here.  All the dentist prescribes is Mefinimic Acid (sp?).  Stuff is a complete waste of time.  The rest of the world uses it for menstrual cramps only - here they say it is powerful mojo.  I asked him for codeine and he freaked out. 

[chris49]

Jon. If I say that's questionable, I'm issuing a professional opinion. I'm a nurse with a fairly high level of position. Earlier Head Nurse of a CCU, General Surgery, Neuro and ER. Hospital Supervisor, 800 beds, all in tertiary care. But I'm not issuing a medical opinion on the case.

I don't overrule what has been done. My comment was did you question the Dr? Maybe you were not there? If you don't question the Dr. it means you accepted the treatment.

I also question the billing. But this is what happens in private hospitals. We go to the Govt Hosp and sometimes we are requested to buy from certain items from outside. Our 2 deliveries cost about 3k each plus a few items we had to buy.

[JonPalawan]

My comment was did you question the Dr?

I am in the process of getting the patient's record then I'll question the doctor, namely, why did you administer high doses, and why did you continue to administer after you knew he had kidney issues?

[expatuk2014]

For me its Aspirin or Paracetamol.

Mother in law in and out of Hospital since Feb  bills  of 28,000php etc

when you check the bill you find things like 800php for the Nurses station 4-5000php for medicines etc etc.

some priced at 300-600php each !

 

I cut my finger once wife insisted " hospital " when we arrived they wanted to do blood tests-xrays-etc etc

I said " no way , just for a cut !! " and home we went little wash, dab of Sudocream and a plaster ! problem solved ! 

 

just a little info if anyone has long term hospital stays take the bills to the mayor !

then to the Governers office, and also to the local senator, and Philhealth , and even PCSO !!

 

we have been given a few thousand back, and we are also getting the next 3 months medicines free also

 

if you know any local ex government officials etc it helps

[chris49]

Yes that's reasonable.

You do understand that private Drs working in a private hospital are government employees doing shifts on their off time and in conjunction with the hospital maybe having a shared office and a shared consultation room.

Govt hospitals allow 24 hours off and on, if 3 Doctor's rotating, that would be about 6 days off every 9 days. The same Docs the collegues are the same ones who shared in the private practice, also rotating, that's why the sign on the door will state those who share the room. And hanging sign denotes which Dr. is there.

You don't have a leg to stand on btw, if you do have any luck getting the medical record. The Dr. will probably not be available to see you. If he did he's going to say the patient signed a general consent on admission and he accepted all treatment thereafter. And he will give the clinical indication for the medication.

[chris49]

Aspirin and Paracetamol are contraindicted in head injury. So that's why Ketesse was chosen. A NSAID, a Non Steroid Anti inflammatory drug. Not really sure about using a branded med or the dosage. But private hospitals do go with branded.

[chris49]

For me its Aspirin or Paracetamol.

Mother in law in and out of Hospital since Feb  bills  of 28,000php etc

when you check the bill you find things like 800php for the Nurses station 4-5000php for medicines etc etc.

some priced at 300-600php each !

 

I cut my finger once wife insisted " hospital " when we arrived they wanted to do blood tests-xrays-etc etc

I said " no way , just for a cut !! " and home we went little wash, dab of Sudocream and a plaster ! problem solved ! 

 

just a little info if anyone has long term hospital stays take the bills to the mayor !

then to the Governers office, and also to the local senator, and Philhealth , and even PCSO !!

 

we have been given a few thousand back, and we are also getting the next 3 months medicines free also

 

if you know any local ex government officials etc it helps

Yes, there's like an 80% rebate in government hospitals for indigent, so your wife must walk it through. There's office for indigent in all government hospitals. Does not apply in private hospital. Unless the Mayor or Governor decides to help.