We all know the idiocy in over-prescribing antibiotics for minor URI’s; side effects, resistance, increased health care costs, etc. I really hate it when patients demand them – it means I have to spend 10 minutes, which could be better served seeing other patients or going to the bathroom, explaining the reasons why the Z-pac is not necessary. Sometimes I have to compromise, I give a “rescue prescription” with instructions on it not to be taken unless symptoms are not better in 4-5 days. Still, people have this idea in their head that if they have a fever (or even worse, that their child has been pulling on his or her ear), that an antibiotic is necessary. Well, I had one case where a patient like this had their comeuppance.
A very demanding 40 year old woman came in with 1 day of dry cough. She claimed not to smoke and had no medical problems. Vital signs normal, lungs clear, afebrile (no fever). I was essentially forced first to do a chest x-ray – but it was my hope that if it was negative, she would not demand an antibiotic. Unfortunately, when I told her is was fine and that she likely had a mild bronchitis – no antibiotic necessary, she looked at me like I was from Mars. After calmly telling her all the reasons for not needing it, she still wanted it – and it was either get into a big argument and likely have her write a letter of complaint to the patient advocate, or just give her the damn prescription. So, I gave her the instructions (and wrote it on the script too) to not take it unless she was not any better in 1 week from the onset of symptoms. I think she felt like she won.
Well, three days later, she came back to the ER – and I happened to be working. I recognised her name and asked the Doc who was seeing her what was going on. “Severe diarrhea” was the reply. I could barely contain my glee as I strolled into her room. It was all I could do to not tell her ” Told ya so! Told ya so! Told ya so!”. I told her I was sorry she was sick – (she still had the cough too) and that “I guess you got one of those nasty side effects I was telling you occasionally happens”. She was like, “Ahhhh! – I feel worse now than before!!!!”. Well, I guess that cured one antibiotic abuser!
Great post. I am still smarting from a patient who had a cold and ear congestion. Her exam was quite unremarkable. She demanded antibiotics and I spent the time explaining that it was viral, blah blah blah. The next day (Saturday) she called me with a victorious tone to tell me she went to the ER and they gave her “strong antibiotics for a terrible infection in both ears. No Way!
I admit it- I am guilty- I love antibiotics- On the other hand, if I wasn’t going in the nasty kid-puking snot-blowing germ infested clinics that I have to go in daily, I wouldn’t need them!
“Still, people have this idea in their head that if they have a fever (or even worse, that their child has been pulling on his or her ear), that an antibiotic is necessary. ”
But where did the people got this idea in the first place? Could it be that it was because doctors used to overprescribe them?
I grew up in a communist country where there medicine was much worse than in the US and where there had been shortages of drugs. But one thing that I learned from my pediatrician is that antibiotics come with potentially bad side effects and should only be taken when absolutely necessary. Which in my case was when I was 15 and had a severe two-sided pneumonia.
The first impression I got of US doctors was that they’d prescribe antibiotics for anything. One time I had a really bad bronchitis. Normally I don’t bother going to a doctor when I get a cough, but this time it was really bad and I had high fever which used to be a bit unusual for me. The doctor examined me, told me it was bronchitis and gave me antibiotics. Well, I trusted the doctor knew what he was doing, so I took them. A week later, not much improvement, but diarrhea. I went to a doctor again because I still had high fever. I said antibiotics didn’t help, he said it was because it was viral. Then he proceeded to give me another antibiotic prescription. I asked him “will it help?” He said “not if it is viral”. So, I said, “no, thanks, why would I take something that isn’t going to help?
This was about 20 years ago before US doctors started to be more careful with antibiotics. But I can’t help wondering if doctors past practice has anything to do with patients’ expectations.
Yes! Precisely! Doctors in this country have totally overprescribed antibiotics for a long time – probably since they were invented! I assume it was because antibiotic resistance was not perceived to be a serious problem as well as a poor understanding of many infectious processes. This obviously contributed to patients’ expectations – which will now take at least a generation to change.
Well, stick to your guns folks! I’ve gotten some verbal abuse also from patients for not prescribing antibiotics for their colds. But I’ve seen 2 patients with severe c.difficile infection, one of whom took some antibiotics on her own, for URI symptoms. She ended up in the ICU with severe dehydration and acute renal failure.
I think that insurance ought to not pay for encounters for colds–that would cure alot of our patients’ propensities to come see us for this, even if it would also hit our pocketbooks.
1. What is happening with the comments section here?
All lines are truncated.
2. How do people with colds find time to go to ERs?
I consider myself lucky if I can simply stay at home
and work from home instead of driving to work…
Sometimes I think that being able to lie down when
you are sick is a luxury.