Be Careful What You Ask For

“Could you come and give me some penicillin?”

Uh oh.  

The guest had a sore throat. He was fifty years-old. The only throat infection that antibiotics cure is strep, largely a disease of children and adolescents. Strep in a fifty year-old is so rare that I’ve never seen a case.

Doctors who prescribe unnecessary antibiotics claim that patients “demand” them. In fact, after I’ve seen these patients, ninety percent are perfectly happy with good medical care. About ten percent seem puzzled but remember their manners. Only a tiny minority give me a hard time.

But a tiny minority of a minority does not equal zero. Over thirty years, plenty of patients have lost their temper or (in the case of women) burst into tears. While not as mortifying as being sued for malpractice, it’s in the ballpark.

Unlike doctors in an office, I have the advantage of a phone conversation before seeing the patient. If a guest hints that he requires an antibiotic, I discuss his symptoms, suggest that antibiotics might or might not work, and try to gauge the likelihood that he won’t take no for an answer.

In this case, the guest seemed particularly assertive. I didn’t want to take the risk, so I referred him to a local walk-in clinic where he’ll probably get his penicillin.

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.

Something to Knock It Out, Part 2

Influenza had afflicted a guest for five days with fever, body aches, and general misery. He had meetings, he said, and needed something to knock it out.

While antibiotics don’t affect influenza, antiviral drugs such as Tamiflu shorten the illness by a day or two. Sadly, they only work if taken within the first 48 hours; afterwards they are useless although doctors continue to prescribe them.  I gave him some useful medicine and told him that flu rarely lasts longer than five or six days, so he would feel better soon.

After I left, the patient went to a local clinic and received the traditional antibiotic which solidified his conviction that I did not know my business. A day after beginning the antibiotic he felt better which proved it. Confronting the hotel manager, he demanded his money back. Guests often believe that the hotel doctor works for the hotel.

The general manager phoned to pass on the request.