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Wed, 21st May 2014

You visit the doctor for a repeat prescription, and inadvertently mention how expensive everything is these days. The doctor grunts, and the computer chatters out a bit of paper, which you gleefully clutch and vanish out the door. Next stop is the pharmacy next door, where the bit of paper is handed over. Come back in ten minutes, the lady in white says. Next day you attack the new box of pills, naturally expecting the usual blister pack of round white tablets.

Shock Horror

But no! There is a bottle half filled with loose pink oval ones, no blister pack. Um, you think. Has the doctor got it wrong. Of course not, you think, as the tablet is downed with a gulp of water. But the niggling thing in your mind says "Something is not right here". The difference of course is that the doctor heeded your call for economy, and now wrote a prescription for a "generic substitute". This is a tablet which in theory is identical to the original brand, but is a cheaper version.


The effect, called "bioavailability" on the body is said to be the same. There may be differences in colour, shape, packaging, bottle or box. There may be a difference in content. The active ingredient is the same, but additional inactive stuff called excipients such as fillers and binders may be different. A new drug has a legal life of ten years. After this, competitors can market it under a different name provided it is shown to have the same beneficial effect.


Thus "brand" and "generic" names are now available for most commonly used medication. Occasionally a patient may react adversely to the different colour, filler or binder, but this is rare. A rash may occur with sensitivity to a colouring agent, for example. Most doctors discuss the matter with the patient before prescribing, and the patient can opt for the cheaper version. It is largely an individual choice. Personally as a GP I prefer to stick to the brand I have used and trusted for years.



I had a very strict moral upbringing, with sex regarded as immoral and unclean, and sin a grievance of immense proportions. Now I find it hard to get this out of my brain, and often become depressed at my actions.


This type of upbringing was the norm in the 1800s and 1900s, and only began to change in the latter part of the last century. Parental control and harsh chastising and punishment began to decline. There is no shame in moral values and ethical standards, but to the point of causing stress and depression is no longer acceptable. You need referral to a counsellor, psychotherapist or psychiatrist. Otherwise, depression and anxiety may soon become a major issue in your life.

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I am a relatively new mum and my child seems to suffer from constipation. Is it OK to give medication?


Simple measures like prune juice, sieved prunes, sieved paw paw are simple and usually very effective. It takes some time for the intestinal system to adjust to the ways of the world outside the heated swimming pool of a former life. But usually it settles down OK, just as the lungs expand and the heart beats regularly. The body has an enormous capacity to adjust and survive.

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I have been on medication for anxiety and depression with the new SSRI tablets (says my doctor). However, although I am much less depressed, I find I suddenly flare up in rage if somebody disagrees, even on smaller issues. I am aware of this but cannot control it.


he SSRIs have certainly made a major positive impact on the management of depressions, adverse side effects are well known. The outbursts you describe not uncommon. Also, in younger persons, there is a well-established increase risk of suicide. Please report this to your doctor. Modification of dose or alternate interventions may be recommended. There is usually a 6-8 week lag between commencement of medication and effect.

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Everybody develops illness at some stage. What is the best action - see the chemist or go and visit the doctor?


Many simple illnesses require neither. Viral infections probably head the list, and mild ones are self-curative. A little rest, fluids and probably pain/fever relief will let nature fix you in a few days. But anything that persists for longer may need intervention. The pharmacy is fine for some, but anything that persists or worsens needs GP assessment. Any form of chest pain, especially if sudden needs prompt medical intervention as it may indicate a heart attack. Then get to a public hospital immediately. The triage system will get you to a doctor rapidly.

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I am a "doctor" but a PhD (academic) kind and not a GP (general practitioner) type. When on a plane I was asked by the hostess to attend a medical emergency. It was very embarrassing when I declined, for it appeared I was shirking my duty to society.


Make sure your ticket simply refers to you as "Mr" or "Ms" and not "Dr", as they usually do. Advertising what is accepted in society as an invitation to assist when medical help is needed and not a good idea if unable to sustain this perception. A medical doctor has a legal obligation to attend medical emergencies, like it or not.

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This health advice is general in nature. You are advised to seek medical attention from your doctor or health care provider for your own specific symptoms and circumstances.



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