A Better Medicine

A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.

I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their pronouncements are often exaggerated. I decided to go.

The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.

Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. Instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.

The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was one of those situations where stopping everything works best. 

Sometimes a Thankless Job

A three year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It might last a few days, and staying in bed wouldn’t make it go away quicker. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

They thanked me as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled, and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial.

Mind you, I had carefully explained that the child would feel under the weather for several days. They had listened and nodded.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The cough hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By the following day she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor? 

Something to Knock It Out, Part 3

Her vacation had been a disaster so far. Worse, when she tried to buy amoxicillin to knock out her bronchitis, the pharmacist told her she needed a prescription. This was obviously a scam to line the pockets of American doctors, the guest added. She didn’t need my services except to provide the amoxicillin, so I should not take up her time.

This monologue occurred in Spanish. I don’t speak Spanish, but I’ve seen thousands of Latin American travelers, so I got the drift.

This lady appeared upset as soon as she opened the door. Apparently accustomed to this behavior, her husband and a child sat in a corner, trying to look inconspicuous. Following my rule (see the post from March 16) I had no plans to refuse the amoxicillin, but first I had to deliver good medical care. I phoned the travel insurance office, and the dispatcher agreed to interpret.

I asked the usual questions; she answered at great length.

The dispatcher translated but summarized her interruptions with: “she’s mad about something.”

The guest rolled her eyes when I put a thermometer into her mouth and seemed impatient during my exam.

When I concluded that she would recover in a few days with or without an antibiotic but that I would give her amoxicillin, she slammed down the phone and waved off my prescription.

“If you don’t think I need an antibiotic then I don’t want an antibiotic. According to you I should continue to suffer. Thank you very much!….”  I’m not certain those were her exact words, but they were close.

I laid the prescription on the bed. The door closed behind me with a deafening slam.

What Antibiotics Do To Your Body

When I started out in the 1980s, pharmaceutical companies sold pills labeled “placebo.” They don’t do that today, so a doctor who wants to prescribe one uses a real drug.

Today’s most popular placebos have names like amoxicillin and Z-pak (azithromycin). These help many conditions but not the respiratory infections for which most are prescribed.

Swallowing any antibiotic kills trillions of germs inside your body. If it’s a placebo, those germs are not causing your problem. Other germs immediately move in. Of course, those are germs that can grow in the presence of that antibiotic. If, in the future, they decide to make trouble, another course of that antibiotic might not discourage them. Do you want that?

Experts have been denouncing placebo antibiotics for decades, but their arguments are feeble. They warn about side-effects and allergies, but these are rare. Most antibiotics, useful or not, are safe over the short term.  
  
The long-term consequences are catastrophic. Soaking the environment with unnecessary antibiotics is giving rise to extraordinarily resistant bacteria. Even today about 40,000 Americans die of infections no antibiotic can treat, and this increases every year.

But who cares? It’s a fact that people with a short-term problem don’t take the long view. That might include your doctor.

Sometimes This is a Thankless Job

A one year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It was not serious but might last a few days. Staying in bed wouldn’t make it go away quicker. The parents should encourage the child to drink, but it was OK if she didn’t eat. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

I gave them my phone number and promised to keep in touch. They thanked me effusively as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial. That was clearly wrong.

Mind you, obeying long and sad experience, I had carefully explained that the child might feel under the weather for several days. They had listened and nodded, but their yearning took priority.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The fever hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She agreed and thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By evening she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor?