Doc: What's so hard with saying "You've got [condition]"?

Miscellaneous and Personal Stuff I Must Share
1

I’ve been suffering from something for going on two weeks now, with a sore throat since Friday or so. Monday into yesterday it even hurt to swallow liquids, though the intensity of the pain is down some today. Anyway, I promised myself yesterday that if I didn’t feel vastly improved when I woke up this morning, I’d go to the doctor, and I didn’t, so I did. Alas, both my doc and his P.A. are out today, and to top it off, there were no openings at all to see anyone in his office, so instead, I’m off to the Urgent Care clinic downstairs.

A $50 urgent care co-pay later, I’m summarizing my symptoms: sinus congestion and drainage with prodigious mucous production and off-and-on low-grade fever for over a week, occasional coughing, but mostly due to tickles in my throat rather than chest congestion (I’d worried about it getting into my lungs because I had pneumonia two months ago and really don’t want to go down that road again); and a sore throat for five days or so culminating yesterday with whitish patches on my uvula and tonsils, which to me suggests strep throat.

I got my vitals taken, the nurse swabbed the back of my throat, and when the doc came in, I ran through the summary again and he looked in my throat and ears, possibly up my nose (sorry, don’t remember). Nurse popped in after a bit, said something about strep throat, and handed the doc the scrips he’d done on his little computer and printed out at her station. Amoxycillin, hydrocodone-based cough syrup, and some high-octane antihistimine/decongestant which he also gave me some samples of. I have cough syrup left over from my pneumonia, so I’m just going to use that if I need it to sleep, but I’ve started on the antibiotic already.

Here’s the thing. He never really gave me a diagnosis. On my copy of the bill, I see that he coded me for acute pharyngitis and acute sinusitus, but those really seem more like symptoms to me than a diagnosis. Strep throat was never mentioned again after the nurse came in, so I’m guessing what she said was “negative.” So, I’m still wondering what the hell I’ve got, which of course makes me wonder if I even need anitbiotics.

But I really don’t understand letting a patient, who may be somewhat distracted by, for example, a significant discomfort every time he swallows, get out the door without saying, “I think you’ve just got a bad sinus infection” or “Looks like a really bad cold to me, just keep hydrated and stay on your meds and you’ll be fine in no time” or hell, something that let’s me come to work and answer the question “So what do they think it is?”

You know? Is it just me?

BTW, this has done nothing but underscore for me how much I love my regular doc.

2

I’d suggest a callback to ask questions. IANAD, but it’s my understanding that taking antibiotics in the absence of a confirmed bacterial infection that requires them is a Very Bad Thing.

I’ve often been prescribed antibiotics for a sinus infection, diagnosis acute sinusitus. Something I read recently inferred that some doctors were having second thoughts about doing that, however.

3

Because medicine is not always an exact science.

4

A doctor should let you know what he thinks is going on, even if the diagnosis is not really firm yet.

I try to make sure that my patients don’t leave my office without a summary talk from me about what I think is going on, what it means, and what needs to be done, along with the “any questions?” ending.

Not all docs do this, sadly. Today I had to tell a patient that while the surgeon took out his cancerous kidney, they found tumor in his liver and lung. The surgical docs didn’t inform him of this fact, despite multiple opportunities to do so with him awake and alert in the hospital after the surgery. Instead it fell to me to tell him, 2 weeks after the surgery, after he was discharged.

5

The problem with that is that giving antibiotics when they’re not really needed tends to breed antibiotic-resistant bacteria (like the recently-notorious MRSA), so handing out antibiotics like candy is bad for society in general.

BUT…for the individual patient, it really isn’t a big deal (other than the fact that antibiotics can cause side effects, like any other drug). So, unfortunately, it is extremely common to give any patient with “acute pharyngitis” (which is just the medical term for “sore throat”, by the way) antibiotics to make sure the patient leaves feeling like you’ve “done something” for 'em.
A lot of patients would be pissed off to have a doctor say, “Your sore throat is probably caused by a virus, so just take it easy for a few days and it will probably go away on its own” after a $50 co-pay, so most urgent care docs will write a prescription for antibiotics whether they’re really necessary or not.

6

Too true.

I think the most common reason for prescribing amoxicillin is to get the patient out of your office.

I write for a lot fewer antibiotics these days, since in my current practice setting, keeping the patient happy is a lower priority, the main goal being taking care of the patient’s actual medical needs.

7

My understanding exactly. I HATE when people do that. Especially when it’s a doctor who should know better! I have given friends and co-workers an annoying know-it-all lecture about the badness of asking for, expecting and/ or taking amoxicillin for an ailment diagnosed as a virus. GAAAAAHHH! You’re helping to breed killer germs! Just as bad or maybe worse are the folks who will take half of a prescription and then stop without checking back with their doctor because they are “all better now, don’t need the rest of it” and end up with a seriously bad infection. And then blame it on the awful state of medicine these days.

Best MDs we had were our kids’ pediatrics group. They would under no circumstances prescribe antibiotics unless they had a positive result on a diagnostic test such as a throat swab. And they didn’t make me feel like an idiot for bringing the kids in. Their attitude was that they’d much rather have a kid come in for the test and find it negative, thus “wasting” the visit, than to miss the times it was strep and they could prevent a worse situation.

8

You probably heard the same thing I did. Sinus infections treated with antibiotics usually get better in about two weeks. Sinus infections not treated with antibiotics usually get better in about two weeks…