Sunday, December 22, 2013

Good Doctors Do It

“I’m coughing my head off. My head is plugged. I have a fever. I’m on vacation, and I need something.”

I’ve seen over 4,000 guests with respiratory infections. To the average hotel doctor, this is an easy visit. He arrives, performs the traditional exam, prescribes the traditional antibiotic, and accepts his fee and the guest’s thanks. What’s not to like?

That the antibiotic is unnecessary doesn’t bother him. It would bother me, so I prescribe only when it will help. Despite my colleagues’ insistence that patients demand antibiotics, most of mine accept this. A minority appear disappointed, and a few make it painfully clear that I’ve missed the boat.

For decades, solemn editorials in medical journals have urged us to stop prescribing useless antibiotics, warning that they’re poisoning the environment, producing nasty, drug-resistant germs that are already killing thousands. 

Despite this, giving antibiotics for viral respiratory infections remains almost universal. Every doctor whose prescribing habits I know – admittedly a limited sample of about ten – does it. None believe they help. All tell me that patients expect them.

“I don’t want an antibiotic if I don’t need it,” intelligent patients tell me. “But how do I know?”

“You don’t, but bacterial respiratory infections are rare in healthy people.”

“What if it’s bronchitis? I get that a lot.”

“Antibiotics don’t help bronchitis.”

“That’s what my doctor gives me. Are implying he’s incompetent?”

“No.  Prescribing unnecessary antibiotics is so common that one could call it the standard of practice – meaning good doctors do it.”

If you’re coughing and in reasonably good health, the only common disease that antibiotics cure is pneumonia (229 diagnoses on my database). Everything else is a virus.

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