With the recent tightening of guidelines on sleeping pills, doctors are now required to advise patients on appropriate sleep habits and are barred from prescribing more than four weeks' supply of pills.
The Straits Times wanted to find out whether general practitioners (GPs) were complying with the guidelines and how easily sleeping pills could be obtained from them.
THE LITMUS TEST
Who: Straits Times journalists Jessica Jaganathan and April Chong
Where: 30 GP clinics - 28 across the island, including a polyclinic, and two in Johor Baru
When: Dec 18 to 23, 2008
How: The journalists approached the doctors, each saying she had difficulty falling asleep at night; each also said previously prescribed pills did not work and asked for something stronger. They complained about work-induced stress and anxiety, and said cutting down on caffeine did not help. The statistics: They each managed to get an average of 10 sleeping pills from 21 of the 30 clinics. The record was 30 tablets of midazolam, also known as Dormicum, from a GP in Johor Baru.
THE RESULT
The good
John Chiam Medical Clinic in Ghim Moh Road
When asked for sleeping pills, Dr Chiam appeared cautious and immediately started keying in the journalist's 'symptoms' into an electronic file.
He showed her a form and explained that he would have to use it to report her to the Central Narcotics Bureau if he suspected she was abusing sleeping pills and remarked that it was strange that his first-time, walk-in 'patient' was far away from her home.
He advised her on good sleep habits and prescribed an antihistamine instead.
Contacted later, he expressed surprise at the ruse, but said alarm bells went off when he noticed that the 'patient' was not one of his regulars and lived nowhere near his clinic.
'I knew you were not an addict but I wanted to be careful anyway,' he said.
Family Health Clinic in Holland Drive
The GP, Dr Clement Lai, spent up to 10 minutes quizzing the 'patient' on her job, social habits, sleep environment and even what she thought about before bedtime.
He said these questions helped him determine whether insomnia or any other problem was causing the problem.
He also checked her breathing and heartbeat to rule out thyroid problems, then taught her simple relaxation techniques and breathing exercises. He did not prescribe any pills.
The average
At nearly 20 clinics, the GPs spent under a minute talking to the 'patient' about her sleep habits; some warned of the potential for addiction. Most also did not ask why the 'patient' had come to a clinic far from home for the pills.
The bad
A clinic in Johor Baru
The GP asked only a few questions and explained briefly that sleeping pills were potentially addictive. He prescribed Dormicum before the 'patient' even asked for them and even said she could get subsequent prescriptions from the reception without a consultation.
A clinic in Jurong East
The doctor asked only if work was stressful before prescribing diazepam. He neither mentioned its addictive properties nor gave advice on good sleep habits. He told the 'patient' that if diazepam did not work, he would give 'something stronger'.
A clinic in Bedok
The doctor asked the basic questions on why the patient could not sleep, and then asked if she wanted 'something stronger than Valium' without her asking. He readily gave an extra 10 tablets when she asked for them after giving her an initial 10.
This article was first published in The Straits Times on Jan 2, 2009.
