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medpundit |
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Wednesday, January 28, 2004CNN had a doctor on this morning who spoke of how physicians often prescribed antibiotics for viral infections knowing full well that it was useless at best. The stated reason for it was patient demand, and the docs didn't have time to explain that the antibiotics didn't work on viruses. This sounded really lame to me, bordering on professional misconduct. I suppose it could be argued that there is a placebo effect, or that the patient would just go shopping for another doc, but even so. Anyway, I thought this might be blogfodder for you. Is this self-prescription something that you see? Don't third parties who pay for drugs say anything about this? At one point does this become an abdication of responsibility? Not only is this something I see, it's something I sometimes succumb to myself. There are no hard and fast symptoms or signs that distinguish a viral illness from a bacterial sinus infection. Most of the time we're guessing. And yet, there is one thing we know about respiratory infections. Most of them are viral, not bacterial. And yet we probably treat the majority of them as if they were bacterial rather than viral. The reason we tend to do that as a profession is patient demand. Believe it or not, patient satisfaction is important to doctors. It wounds our egos when patients leave us, no matter how unjustified their reasons. It is by no means an adequate justification for prescribing needless antibiotics, but it is one of the underlying factors in the psychology of choosing whether or not to use them for upper respiratory infections. I've had plenty of patients leave me because I wouldn't give them antibiotics. Just yesterday one told me he was leaving for another, better, doctor because I wouldn't phone in an antibiotic for his cold symptoms. (Other doctors do it, don't you know?) Insurance companies have no interest in the matter. They're even more attuned to customer satisfaction than doctors are. I once had a patient's wife report me to their insurance company because I wouldn't treat his clear nasal drainage (which he had for less than a day) with antibiotics. She told them I refused to provide him with needed medical care - and that was after I had spent time carefully explaining why it was important to avoid needless antibiotics. (I know about it only because the insurance company called me to investigate the complaint.) The blatant misuse of antibiotics does border on the irresponsible, but I have the impression that fewer and fewer doctors are blatantly misusing them. It's just very difficult to resist the temptation to give in to demand sometimes, especially at the end of a long and trying day. UPDATE: Here's one reader's experience with unnecessary antibiotics: I found myself with a case of laryngitis. The last time I lost my voice it turned out to be walking pneumonia and since I have chronic asthma, I went to see my PCP. He told me that my lungs were perfectly clear and that laryngitis is almost always viral. I said OK and was ready to move along but then he offered me a prescription for antibiotics. I said, I thought you said laryngitis is usually viral. He said it is but if you want the drug for your peace of mind.... I said no thanks and found a new PCP. I avoid antibiotics at all costs because they always give me a raging case of yeast folliculitis on my chest which makes me absolutely insane with itching and takes forever to clear up. Too bad this doesn't happen to more people because I can guarantee they would run screaming for the hills if anyone offered them unnecessary antibiotics. posted by Sydney on 1/28/2004 05:28:00 PM 0 comments 0 Comments: |
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