Comments on: When patients demand treatments that won’t work

By: Carolyn Thomas

Carolyn Thomas — Thu, 12 Dec 2013 12:49:04 +0000

Hi Donna and thanks for sharing your story. Ouch! As in Cherie’s case, the concern is not so much antibiotics for severe and dangerous infections, but prescribing them willy-nilly for every case of sore throat as patients have come to routinely expect. I was surprised by Dr. George Lundberg’s stats, for example, that “the length of time a person with sore throat is symptomatic prior to recovery is four to seven days, whether or not strep is found and regardless of whether antibiotics are used.” For the average, rarely experienced case of sore throat, that’s pretty compelling.

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By: Donna Cusano

Donna Cusano — Thu, 12 Dec 2013 05:36:50 +0000

I have to agree with Cherie. It’s also the track record of the individual patient and knowing what works for you. My tonsils, after a bout of successive infections in my twenties, were declared ‘marginal’ and I was ‘one more infection away from surgery.’ Not a happy prospect.

Fortunately spring came and the infections ended. For decades now, any throat infection predictably goes straight to my tonsils (quite visible) and then to my ears, accompanied by a low-grade fever, I know that I can either hope it goes away (and sometimes it does, only to return) or get it early with azithromycin, full course. Simple stuff that my brother (a doctor, but not an internist) prescribes for me. I don’t take it for anything else, I get predictable gastro-intestinal difficulties right after, but I am not taking the risk of hearing loss or major tonsil surgery. Plus, I know if I go to an ENT, he’ll prefer something heavier duty– I’m allergic to cephalosporins in any form (worst reaction: a 102 degree fever!) which are often prescribed for this.

So your son and his doctor may not be ‘off’ in seeing a pattern and going for what works.

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By: Carolyn Thomas

Carolyn Thomas — Sun, 13 Nov 2011 12:41:13 +0000

Thanks Cherie for your thoughtful perspective. My concern here is the widespread practice of recommending treatments with little if any science-based evidence to support them. Most patients (not just those high-risk exceptions you list) now expect antibiotics for a common head cold, most ear infections, influenza, most coughs, most sore throats, bronchitis, stomach flu and many other complaints for which an antibiotic Rx is proven to be inappropriate.

Thanks for bringing up the important point that not completing a course of appropriate antibiotics is also an issue. Mayo Clinic guidelines, for example, include: “If you take an antibiotic for only a few days — instead of the full course — the antibiotic may wipe out some but not all of the bacteria. The surviving bacteria become more resistant and can be spread to others.”

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By: Cherie

Cherie — Sun, 13 Nov 2011 05:52:01 +0000

However, if your mother or child were one of those 30% that DID need the antibiotic to recover from typhoid fever, wouldn’t you want the antibiotic? If your 18 m/o daughter has suffered from ear infections her entire life and currently has had one that has lasted 6 weeks and is not improving, and her hearing has been permanantly affected, wouldn’t you want her to have an antibiotic? If your child, after innumerable strep infections, was the one case that developed rheumatic fever – wouldn’t you wish an antibiotic would have been given to prevent it? I would rather suffer a reaction to an antibiotic than do without if it could prevent complications.

As an RN, I really don’t believe the resistance is from over-prescribing, but from patients NOT COMPLETING the entire course of the antibiotic. I really feel the answer is INDIVIDUALIZED medicine – a decision made by you and your doctor for your particular case alone.

If the doctor refuses to listen to the patient’s concerns, belittles his concerns, or just has a “no antibiotics unless you are dying” attitude, I don’t blame patients for being upset.

Likewise, if a patient refuses to listen to results of cultures and insists on an antibiotic for a viral infection – then the doctor has the moral and ethical duty to NOT PRESCRIBE an antibiotic. Many times, the prescription pad is “reached for” simply to get out of that room and on to the next patient. I think there are definate faults on both sides of the prescription pad. Education and listening is important on BOTH sides.

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By: Pranab

Pranab — Mon, 31 Oct 2011 05:13:00 +0000

I am at the other end of the nation! Outskirts of Kolkata aka Calcutta…🙂 What are their plans? It is a good time to be visiting India!

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By: Carolyn Thomas

Carolyn Thomas — Sun, 30 Oct 2011 19:52:10 +0000

Okay, PC it is. Where in India are you practising medicine? My son Ben (of the sore throat fame) and daughter-in-law Paula are currently travelling in India for three months (just arrived in Jaipur this week).

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By: Pranab

Pranab — Sun, 30 Oct 2011 19:17:42 +0000

…and we wonder why the rates of antibiotic resistance are ballooning! Ridiculous…

Anyways, wanted to say that I enjoy reading your blog immensely. And I don’t know if I have said it before, I just LOVE the name of the blog!🙂

P.S. Please call me Pranab or PC! Dr. Pranab sounds way too formal… especially for someone who has barely been a fully licensed doc for 6 months!

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By: Carolyn Thomas

Carolyn Thomas — Sun, 30 Oct 2011 13:26:31 +0000

Frustrating and distressing story, Dr. Pranab – especially when you went overboard to provide both lab test results and education to your patient. No wonder so many exasperated docs reach for the prescription pad…

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By: Pranab

Pranab — Sun, 30 Oct 2011 13:15:24 +0000

It does… absolutely!

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By: Pranab

Pranab — Sun, 30 Oct 2011 13:14:18 +0000

Oh WOW! I am writing a similar post on my blog and must say I have had a recent, nasty experience with a sore throat patient.

A few weeks ago, a viral fever was doing the rounds in my locality and a lot of people were catching it. It started off as a sore throat and tailed off after 5-10 days of intense myalgia/malaise/fever.

One person came to me and was especially insistent when I tried to send him off without a script for antibiotics. However, to placate him, I sent off a battery of tests all of which, expectedly, came back normal, supporting my provisional diagnosis of a viral fever. I saw him on the 3rd day of his illness and he demanded, rather vociferously, a script for antibiotics and I refused, explaining the futility of the same in a viral infection. However, he threw me out, got himself a new physician who was too glad to oblige with a script for a 3rd generation cephalosporin, to be taken for 10 days…

About 7 days in, he recovered and started abusing me for witholding the “magic” antibiotic that saved his life!

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By: Carolyn Thomas

Carolyn Thomas — Sun, 30 Oct 2011 12:49:49 +0000

Thanks Dr. Joe – but when the patient’s sore throat or cold symptoms eventually improve (which WILL happen, with or without that Rx), doesn’t this just confirm the patient’s belief that it was indeed the drug that cured the illness?
cheers,
C

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