"Dawa le li thi" — the self medication risks we see every week in Indore

"Doctor sahab, dawa le li thi. Medical wale ne wahi wali de di jo pichli baar chali thi."

We hear this sentence in the first minute of the consultation almost every evening, usually said quickly, almost apologetically. Self-medication is treating yourself with a medicine that nobody has examined you for — and it is worth saying plainly at the start that going to the medical store first is not stupidity. It is a reasonable response to cost, distance, time off work, and a clinic that is open two hours a day.

Most of the time nothing bad comes of it. This piece is about the times something does — and about one consequence that is not only yours. The World Health Organization estimates that bacterial antimicrobial resistance was associated with more than 4.7 million deaths globally in 2021, and that in 2023, 1 in 6 laboratory-confirmed bacterial infections worldwide no longer responded to the antibiotics used against them.

Why "wahi wali de do" makes sense, and where it stops working

Asking for the same medicine again makes obvious sense on the arithmetic. No consultation fee. No half-day lost from the shop. No auto to a clinic that shuts at eight. The chemist is two lanes away, open late, and he remembers what worked last time. That logic is sound, with one flaw. It assumes this illness is the same as last illness, and very often it is not.

Fever from a virus and fever from dengue begin identically. A fungal rash and an eczema patch look alike to anyone who has not held a torch to a hundred of them. Ear pain from wax and ear pain from a hole in the eardrum feel the same to the patient and need opposite treatment.

The medicine that helped in March is matched to March's diagnosis. Repeating it in August is a bet that the diagnosis has not changed, and that is the bet that goes wrong.

Medical store se dawa lena kab theek hai, kab nahi?

Medical store se dawa lena is theek for a short, predictable list, and the list is worth knowing precisely. Reasonable without asking anyone: paracetamol for fever or ordinary body ache, ORS for loose motions, a saline nasal spray, an antacid once in a while, cleaning and dressing a small cut, ice on a fresh injury. Not reasonable without an examination: antibiotics of any kind, anything for the ear that goes into the ear, any cream with a steroid in it, a painkiller taken more days than not, anything for a child under a year, and anything at all when the fever has crossed three days in dengue season.

The dividing line is not how serious you feel. It is whether the medicine can cause harm when the diagnosis is wrong. Paracetamol taken for the wrong reason mostly wastes a day. An antibiotic taken for the wrong reason costs something bigger, and we come to that next.

Antibiotics for a viral illness — what is the bill everyone pays later?

Antibiotics do nothing to a viral illness — and most fevers, sore throats, colds and coughs we see are viral. The NHS states it in one line: "Antibiotics do not work for viral infections such as colds and flu, and most coughs." They do not shorten a viral illness, and they do not prevent it turning bacterial. What they do instead is worth understanding, because this is the one risk here that is not only yours.

Every course of antibiotics kills the ordinary bacteria you carry and leaves behind the few that happen to survive. Those survivors multiply. Do this often enough, across a city, and the common infections stop responding to the cheap, safe, familiar drugs. The WHO names the cause without hedging: "The misuse and overuse of antibiotics, for example taking them when they are not needed or taking the wrong type, remains one of the main drivers of AMR." Our part of the world is already furthest along. The WHO reports that resistance is highest in the South-East Asia and Eastern Mediterranean Regions, "where 1 in 3 reported infections were resistant".

There is a personal cost too. A half-finished course, taken for three days and stopped when the fever settled, is the most effective way there is to breed a resistant infection inside your own body.

What happens when painkillers silence a joint or a headache?

A painkiller taken for a bad evening is reasonable. A painkiller taken most days for weeks is a different thing, and we see it constantly — in knees, in shoulders, in headaches that have been managed from the chemist's counter for a year.

The problem is not only the stomach and kidney irritation these can cause, though that is real, and it is worse in anyone older, diabetic, or on blood pressure medication. The bigger problem is what the tablet erases. Pain is data. Whether the knee hurts at night, whether the headache comes with vision changes, whether it wakes you at four in the morning — those details point to a diagnosis. Silence the pain for three months and you arrive with the same problem, further along, and less to go on.

If you need something to get through the day more often than not, that is not a reason to buy a bigger strip. That is the reason to come in.

"If you are needing a painkiller most days, that is not a dosage question — it is a diagnosis question. Bring the strip with you; nobody here will scold you, and knowing what you have already taken often changes what we look for." — Dr. Arpit Maurya, MBBS, MS (Orthopaedics)

Steroid creams on a fungal infection: why is this the mistake we see most in Indore?

Steroid creams on an undiagnosed rash are the single commonest thing we correct in the monsoon, and the pattern is always the same. A ring-shaped itchy patch appears in a skin fold after weeks of damp clothes and wet feet. Someone recommends a cream — usually a combination cream with a steroid in it, sold without any questions. Within three days the itching stops and the redness fades, and it looks like a cure. It is the opposite.

The steroid switches off the skin's inflammation while doing nothing to the fungus, so the fungus spreads quietly under a calm-looking surface. The NIH-hosted StatPearls reference gives the effect a name: "Tinea incognito is another possible complication of steroid administration where the typical presentation of tinea is masked, and diagnosis is delayed." When the cream is stopped, the patch returns bigger, with a strange faded edge, often across a much wider area. Treating that takes far longer than treating the original patch would have.

Monsoon skin problems in this city are usually about moisture, not about creams. Our article on foot and skin infections after waterlogging covers what actually helps.

Ear drops, and the relative's leftover strip

Ear drops are the fourth item on our list, and the one people are least suspicious of. If the eardrum has a perforation — and a good number of adults have one from a childhood infection without knowing it — some drops can reach the middle ear, where they do not belong. Anyone who has had ear discharge, an old injury, or long-standing reduced hearing should assume nothing about their eardrum. Oil, warmed liquids and cotton buds cause their own trouble, which we set out in our guide to ear wax and why cotton buds make it worse.

The fifth is the strip left over from a relative's prescription, offered in good faith for a "similar" problem. It carries someone else's diagnosis, someone else's weight, someone else's kidneys, and often an expiry date nobody checked. The NHS advice on this is one sentence long: "Only ever take antibiotics prescribed for you – never 'borrow' them from a friend or family member."

Dengue season: the fever where the painkiller choice matters

Dengue season is when the painkiller choice stops being a matter of preference. Dengue and ordinary viral fever start the same way, and there is no reliable way to tell them apart in the first two days without a test. Dengue — one of the 100–400 million infections the WHO counts each year — lowers the platelet count, and platelets are what stop bleeding. So in any fever from August onwards, paracetamol is the safe choice, and ibuprofen and aspirin are not. The World Health Organization is unambiguous: "Non-steroidal anti-inflammatory medicines such as ibuprofen and aspirin should be avoided as they can increase the risk of bleeding." The CDC's dengue guidance says the same — "Control fever with acetaminophen" and "Avoid aspirin (acetylsalicylic acid) and NSAIDs (e.g., ibuprofen)."

This matters because a strip bought over the counter for "bukhar aur badan dard" is often not paracetamol at all, and nobody at the counter asked what the fever was. If you are unsure what you have at home, bring it and let us look. Our article on telling viral fever from dengue covers the warning signs to watch for.

Ghar pe abhi kya karein — what is genuinely safe at home?

• Paracetamol for fever or ache, as printed on the packet, and nothing else in a fever you have not had checked.
• ORS and plenty of fluids for loose motions, vomiting or any fever. Sugar-salt water at home is a reasonable stand-in.
• Clean small wounds with clean water, cover them, and keep them dry.
• Ice wrapped in cloth for a fresh sprain or knock; warmth only for old stiffness.
• Steam and saline for a blocked nose, rather than repeated nasal drops.
• Keep every strip you take, with the packet, and bring it to the consultation. It is genuinely useful information, and it is not evidence against you.

Red Flags — Ghar ka ilaaj kaafi nahi hai

Aa jaiye — agar: the fever has crossed three days, or returns after settling; there is bleeding from the gums, nose or in vomit, or severe abdominal pain; a rash that does not fade when pressed; breathlessness or chest pain; a skin patch that keeps returning or spreading after creams; ear discharge, ear pain or reduced hearing; you have needed a painkiller most days for two weeks; a child under three months has any fever; or you have started an antibiotic without anyone examining you.

Self medication risks: ask us before you buy, at our clinic in Indore

Nobody at this clinic is going to lecture you about the strip in your bag. We would far rather see it. Knowing what has already been taken — and for how long — often changes what we look for and saves a test. The cheapest thing we do is answer the question "should I take this?" It takes two minutes, and it prevents most of what is described above.

Message us on WhatsApp with a photo of the strip, call the clinic on 7869709075, or book an evening appointment on drhealthcare.in. We are open Monday to Saturday, 6 to 8 PM, deliberately after working hours, because we know the timing was part of the problem in the first place.

Questions patients ask us