Sharing
A couple of weeks ago, Jimbo saw a patient in his clinic. He was an intravenous drug user and is currently on opioid substitution therapy. He also has HIV and has been started on anti-HIV medications for a few months now. He seems to be doing well.
Somewhere towards the end of the consultation, he asked Jimbo this:
“Doktor, boleh tak doctor tengok bini saya? Dia tu pon sakit HIV tapi tak jumpa doktor. Entahla, dia tu macam tak sihat. So boleh tak jumpa dia? Dia kat luar sekarang” (Doctor, can you also see my wife? She has HIV but is not on followup anywhere. I dunno, she doesn’t seem healthy. So, can you see her? She’s just outside now)
Jimbo had to say “yes” even though there were many more patients who were waiting to see him.
Jimbo took a quickie history from the hubby before calling the wife in: yes, they are separated; yes, he slept with her even after separation; no, he did not wear a condom; yes, they are staying together; no, the wife has never been on treatment; yes, she had an episode of breathlessness a few weeks earlier…
Then he called his wife in.
It was a like a rush of chilly wind just blew in when she walked in. The wife’s body language indicates that she detests her hubby!
Jimbo had to ask the hubby to step out and as soon as he did, the ice thawed instantaneously! 
Another history taking session in which Jimbo learned that: yes, they are separated; no they have not been sleeping together (phew!); yes, their youngest child died of HIV and that’s when she was diagnosed HIV+; no, they do not stay together; yes, he has started to come back into their (they still have 4 other children) lives and has started contributing to the finances of the family; yes, she was breathless a while ago but she got well; no, she is not sure if she is really HIV+; yes, she wants follow up now; yes, she has been losing weight and her appetite has been poor…
And then she dropped the bomb shell:
“Doktor jangan marah ya. Saya nak bagi tau sesuatu. Jangan marah ya…” (Doctor, please get angry, I want to tell you something. Please don’t get mad)
“Masa saya sakit kan, suami saya bagi saya makan ubat dia. Masa beberapa hari, lepas tu dah okay. Dah sembuh!” (When I was sick earlier, my hubby treated me with HIS medications. I took it for a few days and I got well!!)”
To say Jimbo was stunned is an understatement!!!
Another quickie history taking revealed that the husband had no only fed her with Bactrim (which would have treated her PCP somewhat), he had also given him his anti-HIV medications and she has been taking them irregularly!!!
Gaarrgh!
If eyes could pop out of their sockets, Jimbo’s myopic eyes would have rolled out the door!
Darn! Darn! Darn!!!!
There are a few expletives Jimbo would like to use but can’t here, not on a ‘medical blog’. Apparently swearing is heatlhy! Sigh!!!!
@^&*&^(*&(%$^%^^*^$$$$&*%*$!!!!!!!
Now, the wife is probably resistant to a few anti-HIV medications, EVEN before starting treatment! Oh God! How did things turn out so wrong?
The whole thing is like a bad tragicomedy!
Sigh….
Thurs, 160709 @ 0700
They are not ignorant I feel, just that they didnt receive enough information.
Sometimes we are not sure, sharing brings good or harm?
it was simply lack of education. we have a culture of sharing medication – hands up if your parents have ever kept unfinished medicines in the refrigerator, only to whip them out when someone is ill – and i’m sure he thought he was helping her out by giving her his haart pills. he probably didn’t understand the implications for himself and his wife.
sigh…it’s a tragedy indeed. i guess we can’t do much except do our ultimate best to ensure patients know what they need to know about their illness and medications. whether they choose to recognise the importance of compliance and not sharing prescriptions is out of our control.
thanks for sharing stories like this so we’ll understand the true weight of the task of patient education and constant reinforcement of that knowledge at every consultation.
siao! wat kind of human is this…simply give meds without consulting docs.. mabuk d~~~~
if they think they can do a better job than doc..doc’s all can retire and no need to work already la~~~
so wat would happen to her now? kesian la..
Is there a role to start treatment using the 1st line or proceed straight to 2nd line in this patient? They seriously need a lot of education awareness about HIV treatment.
Not sure, I will need to assess her properly first.
erm…. sharing anti HIV medications like sharing paracetamol! need education need education!
Not the same. Sharing PCM is not potentially life threatening. Sharing HAART to a person not previous exposed to it is extremely dangerous.
Wah such ignorance! Just goes to show how even normal people try to act like doctors these days.
Are you implying that doctors are ‘abnormal people’?