Treating minor ailments yourself?

Patients can often take good care of minor complaints without consulting a doctor. Some experts argue for even more personal responsibility, others argue more cautiously

Germans are very happy to use medicines that they can get without a prescription for minor health problems. The medication can be obtained from the pharmacy quickly and with little effort - competent advice included. Many patients are then fit and productive again just as quickly.

Trend towards self-medication

Whether cough or runny nose, headache or sore throat, whether athlete's foot, sleep disorders or skin wounds - there is a huge range of possible areas of application. "Self-medication is a very central component in our healthcare system and extremely important for patients who seek help quickly and easily," says Fabian Salzl, pharmacist from Bad Rappenau.

In the past seven years, the number of those who get a remedy from the pharmacy for minor complaints has even increased from 53 to 57 percent. Instead, only 42 percent go to the doctor - five percentage points less than in 2012.

While fewer people have been going to the doctor since 2012, more patients are turning to over-the-counter products.

See a doctor if you have complaints
2012: 47%
2019: 42%

Get me funds from the pharmacy
2012: 53%
2019: 57%

In 2018 alone, 624 million packs of over-the-counter medication crossed the counseling desks of German pharmacies. At the same time, many doctors recommended more than 155 million packs of these preparations using the green prescription.

Experts demand more personal responsibility

The health economist Professor Uwe May advocates further strengthening self-medication. May teaches at the Fresenius University of Applied Sciences in Wiesbaden and has been working intensively on the subject for many years. He justifies his demand for more personal responsibility on the one hand with the time saved, which would not only relieve the patients, but also the sometimes overcrowded practices.

"This would enable us to free up medical capacities that would then be available to other, more important cases," argues the expert. More time also means more success in therapy.

Are waiting rooms blocked?

When it comes to the number of doctor visits, Germans are currently in the lead. According to statistics, every German citizen visits a doctor an average of 18 times a year. For comparison: the French only have about five doctor contacts.

However, pharmacist Fabian Salzl suspects that many complaints do not necessarily have to be treated by a doctor: "I do think that many people block waiting rooms that actually don't need to be there - especially in the emergency outpatient clinics outside of normal office hours."

Nevertheless, according to the Federal Association of German Pharmaceutical Manufacturers (BAH), around 100 million minor health disorders are treated in medical practices in this country every year.

More over-the-counter medicines

At the same time, a BAH report shows that self-medication is already relieving the statutory health insurance funds by around 21 billion euros per year. The health system therefore benefits when patients resort to over-the-counter products.

So-called switches are an important instrument for this. In technical jargon, this is the name given to drugs that are released from the prescription requirement because they have proven to be sufficiently safe. They are gradually expanding the range of medicines that are available for self-treatment.

In addition to over-the-counter medications, home remedies are also popular for alleviating everyday problems

© W & B / Eda Calisti

For example, some migraine patients can hope that further active ingredients for their ailment will soon be available in pharmacies without a prescription. There could also be more over-the-counter remedies for mild eye infections, hay fever and acne in the future.

Prescriptions from pharmacists

"We pharmacists, of course, deal with new switches with a very special duty of care," says Fabian Salzl. Around 85 percent of pharmacists and 51 percent of doctors spoke out in favor of more switches in a representative survey, reported Professor Niels Eckstein from the University of Kaiserslautern at a specialist conference. According to the survey, more than half of consumers would be happy about the release of additional drugs from the prescription requirement.

"At least every second patient only visits his family doctor because he needs a sick note or a prescription for a drug he already knows," says health economist May. His vision: In certain cases, the pharmacist could issue prescriptions and sick notes.

Budget for self-medication

This would leave one of the main problems with switches and over-the-counter drugs: the cost. Because although the funds mean a gain in time and convenience for the patient, they also put a strain on their wallet. After all, over-the-counter medicines are only reimbursed by statutory health insurances in exceptional situations - this means a financial challenge, especially for low-income earners.

May has another idea for this: "If the health insurers were to provide each patient with a kind of self-medication budget - for example in the order of 50 euros - the insured person could get his over-the-counter medication from the pharmacy if necessary." The health insurance company may save the cost of a doctor's visit.

"The first point of contact for patients remains"

But not everyone sees the expansion of self-medication as positively as May. The family doctor Anke Richter-Scheer from Bad Oeynhausen, for example, is skeptical: "Even if there are certainly many banal cases in the practices, we want to remain the first point of contact for the patients."

The current system of family doctor-centered care is effective. The family doctor decides, among other things, whether the patient needs to be referred to a specialist or whether self-medication with over-the-counter medicines is sufficient.

The Karlsruhe orthopedic surgeon Dr. Johannes Flechtenmacher from the Professional Association of German Orthopedists and Trauma Surgeons similarly: "We cannot decide what is right and wrong for others." If patients think they need to see a doctor, they shouldn't be stopped. After all, not every patient can always judge unequivocally whether their complaints require a medical diagnosis and therapy or not.

Searching for causes on the Internet often unsettles laypeople

A representative survey by the polling institute Nielsen on behalf of the pharmaceutical manufacturer Sanofi has shown: Four out of ten German citizens cannot assess for themselves whether they are really sick, if something hurts them or if they feel unwell. And almost every second person searches the Internet for possible causes for their symptoms instead of immediately asking an expert.

Anke Richter-Scheer, family doctor in Bad Oeynhausen and member of the federal board of the German Association of General Practitioners

© W & B / Felix Hüffelmann

However, this can be risky: "It always depends on how the patient deals with the information," says family doctor Richter-Scheer. Many do not interpret the information on the net correctly, then the worst illness is often stuck in the memory as a possible diagnosis. Patients panic unnecessarily.

However, it becomes even more problematic if someone treats himself incorrectly or not at all due to the incorrect assessment and thus risks worsening the disease.

At this point, at the latest, the local pharmacist should come into play as a so-called health guide. As part of a detailed consultation, he can question the patient's self-diagnosis and, if necessary, send him to the doctor.

Help from the pharmacy

In a conversation, the pharmacist can find out which drugs are suitable for the person concerned, whether herbal medicines are suitable and which additional measures can be useful to get the complaints under control.

"In personal contact, you will notice many things that are important for the right choice of medication," confirms pharmacist Salzl. This could be, for example, a cramped posture, a conspicuous skin texture or existing overweight or underweight.

"Advice from the pharmacist is particularly important when it comes to self-medication," says general practitioner Anke Richter-Scheer. At the same time, however, it promotes intensive cooperation between doctors and pharmacists - especially among older people and the chronically ill, who should definitely have their complaints clarified by a doctor: "As a rule, there is a good connection between the doctor and the pharmacy on site." And that ultimately benefits the patient.

Self-medication - Here's how you can help yourself

This is how I stop a headache

Pressing pains that wrap around the skull like a ring are typical of the particularly widespread tension headache. The symptoms often improve with activity. Nevertheless, they significantly reduce the quality of life.

This is how I prevent it

Regular endurance sports such as jogging, cycling or swimming are important - ideally two to three times a week. Relaxation exercises are also useful, for example Jacobson's progressive muscle relaxation. Anyone who suffers from psychological or emotional stress can benefit from stress management training.

What I can do myself

  • Apply mint oil to the temples
  • Take pain relievers such as ibuprofen, acetaminophen, or acetylsalicylic acid to relieve symptoms

When do I have to see a doctor?

  • For complaints that last longer than three days
  • When you need pain relievers ten or more times a month
  • In the case of extremely severe pain, fever, symptoms of paralysis, clouding of consciousness or eye pain
  • If it occurs for the first time in advanced adulthood
  • If migraines are suspected

migraine

The pain is usually one-sided. Affected people are often sensitive to light and noise. Usually complaints such as nausea, dizziness or visual disturbances are added.

Headache diary

Make a note of when, how long, and how severe the pain occurs. The entries will help your doctor diagnose. Corresponding templates are available on the Internet, at the doctor or in the pharmacy.

I do that for my back

Millions of people in Germany suffer from back pain. Above all, the lumbar region and the neck cause discomfort.

What I can do myself

  • Take care of your body - but only until movement is possible again
  • Baths, heat packs or plasters loosen tense muscles
  • "Bandages (orthoses) stabilize the back", recommends the orthopedic surgeon Dr. Johannes Flechtenmacher
  • Take pain relievers such as ibuprofen or diclofenac. Be sure to seek advice on this

Important alarm signals

  • Pain after a fall or accident
  • Fever, feeling sick
  • Tingling and numbness in the arms and legs
  • Problems urinating

8.3% of all absent days are due to back pain

Source: Techniker Krankenkasse 2019

Prevention:

Regular exercise and strengthening exercises prevent stress-related back pain.
In the supine position with knees bent, lift your buttocks and slowly lift and straighten your legs alternately - five times on each side (see illustration).
A total of three repetitions.

Now I sleep better again

Often it is stress that does not allow us to relax. Shift work, jet lag or some medications can also lead to problems falling asleep and staying asleep.

How much sleep do you need?

Experts recommend 7-9 hours of sleep per night for adults between the ages of 26 and 64
Source: National Sleep Foundation

Tips for my sleep hygiene

  • Maintain regular sleep times
  • Refrain from taking an afternoon nap
  • Avoid alcohol and large meals in the evening
  • No caffeine after noon
  • Do not exercise vigorously two to three hours before bed
  • After 20 minutes of insomnia it is better to get up and only go back to bed when you are tired

Self-medication

Herbal medicines with valerian, lavender, passion flower and hops have a calming effect and stimulate sleep. However, it often takes some time for an effect to occur.
Synthetic agents such as doxylamine or diphenhydramine can be useful in individual cases.

But they also reduce the ability to drive and increase the risk of falls, especially in older people. They must not be used at all for a number of diseases. Ask your local pharmacy for advice.

This is how I help my bowels

Medication for diarrhea is an important part of a first-aid kit. It is not uncommon for drastic climate changes, unfamiliar dishes or poor hygiene to cause the unpleasant symptom. Mild forms can often be stopped with self-medication. But the transition to forms that require treatment is not always clear. Professional advice is all the more important.

This is how I protect myself

  • Pay attention to hygiene, especially in the kitchen
  • Whenever possible, only eat well-cooked food or self-peeled fruit while on holiday and avoid ice cubes and tap water
  • Wash your hands frequently. This reduces the risk of infection
  • Probiotics stabilize the intestinal flora - for example before antibiotic therapies. They are also suitable for treating mild forms

I can do that myself

  • Constipating foods such as bananas, rice or rusks for mild ailments
  • It is better to avoid coffee or spicy foods as they tend to stimulate bowel movements
  • Preparations with electrolytes and glucose compensate for the loss of fluid and salt
  • After consulting your doctor or pharmacist, agents with active ingredients such as racecadotril or loperamide can temporarily stop the diarrhea
  • Relaxation measures help when stress or nervousness are the cause of the symptoms

When do I have to see a doctor

If the diarrhea persists for more than two to three days, or if it recurs frequently, a doctor should be seen.
If symptoms include fever, vomiting, severe and bloody diarrhea or colicky pain, a doctor must be consulted immediately.
Immune-weakened and chronically ill people should always have diarrhea problems clarified by a doctor.

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