Another physician, and a chief sinner, weighing in…
On the Post Antibiotic Era question: Nah. I’m pretty sure we’ll figger it out. We’ll bumble through. But it will be unnecessarily expensive…then again; so is the rest of medicine. For what it’s worth, I still recall vividly my very first antibiotic lecture in med school. The topic: How antibiotics are becoming obsolete because of overuse and development of resistance. That was in the 1970s. This is not to minimize the problem, but simply to point out that we are great at finding interesting angles to complicated issues, and Danger Danger Danger to Mankind is always an interesting angle, be it AGW, Terrorism, MAD, Big Comets or Germs. Of course, someone will eventually be able to say, “Told ya!”
On the sinner front. 30 years, give or take, of prescribing; much of it in the ED. Plenty of personal sin to report, which is why I am reluctant to criticize.
I used to be more of a purist, but as it turns out, it pretty much isn’t worth it. I could give a very interesting and persuasive lecture, I think, on not treating most (almost all) suspected Otitis Media with antibiotics. I could wax on for quite a bit about how suspected Strep Throat probably isn’t, and how without using serial anti-streptolysin O levels, I’m unimpressed that your “Strep Test” was positive, given the carrier rate for asymptomatic strep. I could carry on about how injectable penicillin is the real gold standard for treatment; how you are not really allergic to penicllin, and how weak is the evidence that antibiotics reduce the incidence of post-streptococcal glomerulonephritis; how infrequent is the incidence of rheumatogenic strains of strep; and how self-limited is strep pharyngitis…I could go on.
But…I don’t have time to teach a patient medicine, and it turns out that most of colleagues don’t either. I’m not sure it’s easy to get across the topics and their nuances within an hour, much less 15 minutes. And I am actually pretty darn good at communicating with patients. Worse, “patient satisfaction,” score reporting, and any number of other drivers conspire to make a patient’s request fairly high on the totem pole of what should really be a medical decision. It doesn’t take very many pissed off moms getting an antibiotic the following morning from their pediatrician to cure an ED physician of her desire to educate the world on appropriate antibiotic use. And to make matters worse, patients often come in internet-educated just enough to know that amox is only a “go-away” potion, and one should really ask for “the white stuff” (zithromycin, say).
It’s kind of a mess, and the giant conspiracy among us physicians to blow off patients with a prescription while the pharmaceutical giants send us to Bermuda only makes it worse…
What I end up doing is handing many a patient a prescription and suggesting they not fill it unless they substantially worsen, or unless a followup call with their physician suggests they take the antibiotic. Very weasly of me, I know. But there’s my confession.
It’s a real pleasure to get the occasional patient bright enough to understand the concepts with reasonable enough rapidity, and trustworthy enough to execute an appropriate decision. We need more Dopers, and fewer regular polloi, visiting the ED.
:smack: However, a nurse did point out that the patient may have been allergic to the plastic in a Fleet’s Enema bottle. That makes my nether regions cramp up just thinking about it.
is looking up excipients, because they are listed there.