This is a two-part question: I’m curious… I have tonsilitis which I self-diagnosed with a AMA book (as well as a Merck book). Very painful and difficult to swallow,
with a modest appearance of white spots left and right of the pharynx, I have no other symptoms. It has remained stagnant for about a week - progressing neither for the better nor worse. At first, I thought it was just a sore throat and I monitored its progress - or lack there of. It is VERY annoying!
(A) Friday, I decided to call my doctor’s office and describe my symptoms. I was wondering if a visit was necessary for such a small thing. To my surprise, the doctor was willing to call-in an antibiotic upon my request - sire unseen. Is that unusual? (Granted, he had seen me for a routine check-up about two weeks prior.)
(B) Then secondly, a major chain pharmacy botched up the handling of my Rx, and it appeared that the doctor never called! After drs’ hours, I had contact his on-call assistant (covering from his own independent practice) to phone something in. He, too, was willing to do so on my say-so. (He did not know I had a check-up two weeks prior.)
Is part (A) unusual? Is part (B) even more unusual? I’m sure these doctors wouldn’t just risk everything on my mere say-so, so I trust this is nothing surprising.
I know policy may vary dr to dr, state to state, but does this surprise you, too?
Yes, I understand your concern. But, even I had been seen by the doctor, wouldn’t he still have made the same diagnosis? And, would say “no thanks, doc”? How else are you going to cure the infection?
For me, it would depend on my relationship with my doctor. When I was pregnant with my second child, I had recurrent UTIs. After seeing me for them three times, the doctor came to believe that, when I said I had a UTI, I knew what I was talking about. After that, a phone call to her office would get me the requisite antibiotics. My urologist, OTOH, has been dealing with me for seven years, and still has me come into the office whenever I call and tell him I have an infection.
In short, if you have an ongoing relationship with your doctor that would allow him to trust you 100% that the symptoms are what you say they are, he may very well be capable of prescribing over the phone. As for his assistant doing the same, isn’t it possible that the assistant knew the doc was supposed to phone in the 'scrip and didn’t? If so, nothing unusual about the assistant doing it. If the assistant didn’t know that the doc wanted the 'scrip for you, then yes, the assistant doing it is unusual, and, IMHO, unprofessional.
True, Jinx. But this business of a doctor going by a patient’s word over a phone as to whether there’s a bacterial or viral infection sounds a tad unsettling to me. I trust that you knew what you were doing, don’t get me wrong – but still. For me, I’d sooner do stuff like that face to face, with an examination.
Medical practice standards in the US expect the doctor to confirm that such a condition is actually a strep infection, as about 75% of sore throats that look and act and smell like strep are not actually strep, but caused by viruses which would not be affected by antibiotics.
The doctor should have had you come in for a rapid strep test, done in the office, with the results available in 5 minutes.
Your doctor’s practice in this case, as described, did not meet the medical standard.
That does seem odd, but I’ve seen/had prescriptions called in before. My mom, who is very prone to sinus infections, had the same doctor for 10 years. After a while, she could just call and say, “I have a sinus infection,” and he’d prescribe something over the phone. The new doctor she has (due to an insurance change) won’t do that, though. That means that my mom won’t get treatment, most of the time, since getting an appointment at the new doc takes over a week.
I’ve had prescriptions for birth control pills called in, but that’s not quite the same thing.
If I have a patient who I know has a history of chronic or acute recurrent sinusitis, I will prescribe without seeing, if I have seen them recently and have documented the condition. Same for women with recurrent bladder infections.
But unless a patient has a definite history of culture-proven strep infections, I won’t do it for a sore throat.
I left a doctor once over this issue. I had been a patient at the office for ten years or so–from the age of about 10 to 21. However, I had been switched over to a new nurse practitioner who came on board. The first couple times I saw her she insisted I come back for six-weeks follow-up visits on a sinus infection. This seemed odd to me, and a huge pain in the ass ( I was working in in school full time) but I tolerated it. In October, I began a serious relationship (with my now-husband) and called for a perscription for BC pills. I’d been on BC before, but when I had gotton my pap four weeks earlier, I told her that I didn’t see the need for BC any time in the forseeable future. Despite the fact that I had had my annual check up just a few weeks before, had no infections or anything, had experience using BC pills, and a ten year record as a reasonably stable patient at the office, she insisted I come in for an appointment. Best I can remember, nothing happened at the appointment, except she explained how to take BC pills. She may have given my another pelvic or a pregnancy test, but I wasn’t, at that time, sexually active. I was the sort of sober, mousy college student who waited until after a full month of being on BC pills before I became sexually active. That was irritating, but when she told me to schedule a follow up appointment six weeks later (for what? I have no idea), I found another doctor. I felt like she was padding her appointment books, and costing me desperetley-needed money because I had to take time off work. I suppose I should have asked to be switched back to the other nurse-practioner, whom I loved, but at 21 it seemed easier to move than to complain and maybe get someone in trouble.
I’ve always kind of wondered if my outrage was correct or if she was really follow medically correct procedures and just didn’t think to explain them to me.
When they put me on birth control pills, the clinic wanted to see me about six weeks in. They basically wanted to make sure everything was okay–no rises in blood pressure, no abnormal reactions, no side effects that were making it hard to take that particular pill, etc. When they started me on Depakote, they wanted me back in six weeks to see how it was working out for me and for blood tests. AFAIK, a followup to make sure things are going well is pretty standard for starting a patient on any new long-term medication, even if they’ve taken it in the past with no ill effects. It’s easy to say, “oh, but it’s just birth control,” but even the most commonplace and innocuous medications have the potential for very serious side effects. A lot of health-care providers prefer to err on the side of being too thorough than not being thorough enough and missing something important.
So true. I’m working in a pediatric outpatient clinic this month and about 75% of the patients I’ve seen have had a viral cold. The thing about sore throats and tonsillitis is that they all get better on their own, regardless of what we do to them. The thing in particular about strep throat that makes us want to treat it are the long term sequelae that can result from an untreated infection, most notably rheumatic heart disease (though interestingly, treatment does not protect against post-infectious glomerulonephritis). So like QtM says, it doesn’t make sense to call in a prescription for a sore throat if you don’t know it’s strep.
Also the rapid strep test is about 90-98% sensitive but only when the swab is properly obtained (very difficult in a 3 year old, let me tell you). The follow-up culture is much more sensitive and specific.
My other pet peeve this month is people coming in who ‘have the flu.’ I say “oh really? how do you know?” They say, “Because I don’t feel good.”
Folks, the flu is a specific illness caused by the influenza virus. We can test for it, and we can treat it if we catch it early enough. But every cold you get isn’t the flu and isn’t going to kill you.
LOL. I"ve ranted about this very thing before. If the patient says “I have the flu”, the chance is about 1% that they actually have influenza. If they say “I’ve got a touch of the flu” the chance falls to 0.01%.
Really? So what is it that most people have when they have all those flu symptoms? Is it just a cold or something?
Seems like everyone around here has it now. A girl at my work spent the last two days taking her temperature and coughing and blowing her nose. She wouldn’t go home either, and I swear if I get sick I’m going to kick her! /rant
Yup. One of the thousands of upper respiratory viruses. Or a gastro-intestinal virus, or food poisoning.
Influenza is a nasty disease which is pretty incapacitating, and kills 30,000 people in the US each year. High fever, horrible cough, terrible aches and pains in the muscles and joints. Lasts up to two weeks. Someone with influenza is unable to go to work.
Best test: a person who is sick is lying on a couch. They see a $100 bill on the lawn outside. If they get up to go grab the bill, they don’t have influenza.
My rule of thumb is (IANAD) if someone is well enough to communicate “I have the flu”, they probably don’t. Two of my coworkers had actual influenza, and the most either of them could say is “I’m dying” click on the phone. The misery was honestly incapacitating.
Maybe, maybe not. Strep throat is a bacterial infection caused byone of the members of the Streptococcus family. It can only be diagnosed by swabbing said throat, and looking for and finding the Streptoccus organism. Then and only then should antibiotics be ordered. You mentioned that you didn’t have a fever. Bacterial infections are more likely to cause a temperature elevation than viral infections.
Viral infections have virtually the same symptoms, and are unaffected by antibiotics.
Also, your symptoms could be caused by a different bacteria that isn’t sensitive to the antibiotics you’ve been given requires.
The practice of arbitrarily prescribing antibotics without identifing the causative agent not only increases the chance that a particular bacteria will become resistant to the antibotic du jour, but your recovery could be delayed because the antiboitics perscribed are ineffective.
Some how I dropped through a time warp here. I swear there were only 4or 5 posts when I started writing, what is now, old news. So my real answer is: What they said.
Docs, when was the last time you had the flu? Mine was in 1978. don’t tell, but I’ve never had a flu shot either, touch wood (knocks fist on head.)
I had a doctor once that I hadn’t seen in five years give me an antibiotic when I called to get an appointment for an earache. I think that might take the cake.
