Dr. Richard Sagall’s article “Can Your Patients Afford the Medications You Prescribe?” [April 2006] reminded me that the rising cost of medical treatment is an issue with patients and physicians throughout the world. As a family physician working with the urban poor in India, I face this issue every day. I am fortunate to have cheap, reliable generic drugs for many conditions; the cost of 50 mg of atenolol is one cent!

I used to work in a hospital that required the doctors to write the cost of the drugs we prescribed on the side of the prescription for the purpose of easier billing. We knew the cost of all the drugs that we prescribed. Now I work in a hospital that does not require me to do that, but the experience helps me keep tabs on the cost of the drugs I prescribe. We help our patients get their medications in two ways:

1. We refer them to the nearby government hospital for the drugs. These hospitals are terribly overcrowded and understaffed, but the patients manage to get free drugs even though they may not be examined. Then we follow up with the patients in our practice.

2. We write prescriptions for longer periods whenever possible. Most of our patients are laborers who do not have enough money to buy drugs for a long period, but this approach enables them to buy drugs for a short period and then buy more later without seeing the doctor first.

As family physicians, we offer the most cost-effective care to our patients. It is important that the cost is controlled not just by the judicious use of drugs, but also by the practice of clinical medicine that focuses on a good history, physical examination and appropriate use of investigations.