The workshop focused on reducing unnecessary intravenous/intramuscular vitamin injections in primary care, examining various factors contributing to their prevalence, including patient demand and cultural beliefs. It aimed to raise awareness, identify practical solutions, and foster collaboration among general practitioners to issue a position statement and recommendations. The event included keynote lectures and interactive workshops designed to explore patient demographics and brainstorm effective strategies for reducing such practices in healthcare.

1. Workshop on
“ How to reduce
unnecessary IV/IM vitamin injection
in primary care”
Introduction
Dr Aung Pyi Soe
M.B.,B.S (YGN), Dip. Med. Sc (Family Medicine)

2. Myanmar belief
အ ားေ ဆား = အ ားရွိ

3. IV/IM vitamin injection
• Vitamin B complex ( B1 + B6 + B12)
• Vitamin B1
• Vitamin B12
• Vitamin C
• Glucose 25%, 50%
• Glucose + multivitamin infusion
• Calcium gluconate
• Amino acid injection

14. Strange!
• A lot of such practices are present around us.
But,
• Nothing was seen in the medical textbooks.
• Nothing was taught in the medical schools.

15. Factors promoting vitamin injections
• Patient factors
• Doctor factors
• Health system factors
• Culture factors

16. Factors promoting vitamin injections
Patient factor –
• patient demand – dependent psychologically on
injection
• perception on treatment – will get better by
injection rather than oral, one can see skill of a
doctor
• Health belief – I will boost my energy by this
injection

17. Factors promoting vitamin injections
Doctor factor –
• Finances – doctors are underpaid or greedy
• Poor knowledge on disease management –
do not know what the patient is actually
suffering (failure of continuous professional
development)

18. Factors promoting vitamin injections
Health system factor –
• Poor regulation on quacks and drug shops –
more pressure to use injection practice that
cannot be used by non-medical personnel
Culture factor –
• Family and society pressure – all the people
are doing
• Pain culture – no pain, no gain (will get better
if I receive pain by injection)

19. Ethical points of view
• လူန က ေ တ င္ ားဆွိိုလွိို႔ ထွိိုားေ ပားတ ပါ။
Autonomy ≠ Right to demand
Autonomy is right to deny and right to know.
• လူန စွိတ္ေ က်နပ္ေ အ င္ ထွိိုားေ ပားတ ပါ။
Beneficence ≠ making patient satisfied
Beneficence is doing good for the patient.
• အ ားေ ဆားထွိိုားလွိို႔ ဘ ဆွိိုားက် ွိားမ မျဖစတ ။
Non - maleficence ≠ avoiding death and disability
Non - maleficence is not doing any harm.

20. Professional points of view
• Doctors are professionals.
• Being professional is fulfilling the client needs
with the understanding of the risk and
benefits of any service given in terms of the
best interest for the client.
• Practicing medicine is not doing a business.

21. More importantly, people should be able to expect more
from physicians. Patients come to us for genuine answers—if
they wanted a witch doctor, they would have found one. I
think we need to hold ourselves to a higher standard than a
huckster at the carnival. We’re not here to promise that we’ve
got all the answers. We are here to be honest, and to use the
best knowledge that science has to offer, using genuine
compassion and thought. Let’s leave the quacking to the
quacks. We’ll stick with real medicine.
Roy Benaroch, pediatrician
Februrary 3,2013
http://www.kevinmd.com/blog/2013/02/fetish-vitamin-b12-shots.html

22. Problem?
• Is it the problem?
• Yes, it is.
• Is it manageable one?
• Yes, it is.
• Why wouldn’t we do?
• Because, we don’t know how.
• Then, we will together find out the solution.

23. Today is the history
Workshop on
“ How to reduce the unnecessary
IV/IM multivitamin injection
in primary care”

24. Objectives
• To increase awareness of the problem of
unnecessary IV/IM vitamin injection among
doctors and public
• To find out the practical solutions to reduce
unnecessary IV/IM vitamin injection
• To collaborate among the GPs in reducing
unnecessary IV/IM vitamin injection
• To announce the position statement and
recommendations to reduce unnecessary
IV/IM vitamin injection in primary care

25. Agenda – morning session
Time Topics
8:00-8:30am Registration and morning tea
8:30-8:45am Introduction Dr Aung Pyi Soe
8:45-9:30am Keynote lectures
1) Scope of the problem Dr Kyaw Thet Soe
2) Biochemical and nutritional aspects of
IV/IM vitamin injection
Dr Theikdi Oo
9:30-10:30am Discussion from audience
10:30-12:00am Workshop 1
Who and why the patients are received Vit
injection?
Facilitator – Dr Kyaw Thet Soe
12:00-12:45pm Lunch

26. Keynote lecture themes
• IV/IM vitamin injection is the huge but covert
problem in primary care practice that uses up
the health resources – medications, money,
human, time.
• This practice is questionably beneficial to the
patient but definitely harmful to individuals
and public in some extent – in terms of
contents and ways of administration

27. Workshop (1) objectives
• to find out what is the patient population that
are receiving the treatment
• to stratify and classify this population
• to dig into the idea, concern and expectation
of those patients

28. Agenda – afternoon session
Time Topics
12:45-2:15pm Workshop (2)
Various ways to reduce
unnecessary IV/IM vitamin
injection
Facilitator – Dr Aung Pyi
Soe
2:15-2:30pm Afternoon tea break
2:30-3:30pm Conclusion
Finalizing position
statement and
recommendation

29. Workshop (2) objectives
• to brainstorm ways to reduce unnecessary
IV/IM Vit Injection together with advantages
and disadvantages
• to decide and list the effective ways on the
board to use in reducing unnecessary IV/IM
Vit injection
• to draft approach to use the various ways to
reduce unnecessary IV/IM Vit injection
• to present the draft approach and discuss the
practicability and pitfalls

30. Summarization
• to write the position statement as a workshop
output
• to write the recommendation for reduction of
unnecessary IV/IM vitamin injection as a
workshop output
• to plan for future task

31. THANK YOU