October 21 2014, 10pm
It's funny. When I worked in the urgent care, my biggest annoyance was not the Percocet seekers. I had dealt with them plenty when I worked in the ER. What drove me crazy was the antibiotic seekers. They would come in at the first sniffle or scratchy throat and demand a Zpak. If denied, they would get petulant and offended. If I tried to explain about viruses vs bacteria and the issue of antibiotic resistance, the patients would tune out. Sometimes the doctors would just write the Rx to make the person be quiet and to have a satisfied customer. How do you handle it when a patient demands an antibiotic, but doesn't really need one? Thanks!
You’re right: the Antibiotics-For-Every-Symptom patients are quite annoying.
My strategy is kinda flexible, depending on my perception of the patient’s I-IQ (Infection Intelligence Quotient). I have honed down my speech on “antibiotics don’t kill viruses” to about 30 seconds; with an extra 20-second-addendum of “these are the risks of antibiotics that I see every day: diarrhea, rashes, lingering stomach problems, resistance, thrush, vaginal yeast infections…” if the patient still doesn’t seem convinced.
Then, if they still insist, my closing sentence is:
I strongly feel that an antibiotic will not help your viral illness at this time, but I will give you a prescription for an antibiotic today, in case you develop a bacterial infection on top of this virus. On the back of the prescription, I’m writing down the symptoms that I would consider as “reasons to start taking the antibiotic” [obviously, these symptoms vary from case to case, but the list always includes ‘if your current symptoms do not get ANY better in 3-7 days’] — if I were you, I would wait a couple more days, because you may be just on the verge of getting over your viral illness.”
And that’s it! Sometimes I’ll modify my approach, and ask them to call me at the urgent care in 3-5 days if they still feel sick, so we can discuss an antibiotic Rx vs. recheck at that time. (Since after all, if they are getting worse, perhaps a doctor should re-examine them before just throwing medication at them!)
Also, a study found that referring to patient’s upper-respiratory-viral-infection diagnoses as “head colds" and "chest colds” (instead of “sinus infection” or “bronchitis”) helped patients to be more accepting of the viral etiology to their illness, and less likely to feel that they need an antibiotic. So I try to use those terms prominently when I discuss their diagnosis.
I knew a doctor who would be a bit more passive-aggressive than I am (I know, right? Hard to imagine.), and when the patient would demand antibiotics, would tell them “I don’t think it’s going to help you unless you are still sick in a week” — and then on the prescription, he’d write a “start date” of 1 week from now, so that when the patient would rush over to the pharmacy right away to get it filled, they’d be told, “This Rx isn’t good until next week." :)
From the Archives: Dealing with the Antibiotic-Seeking Patient.
UPDATE on the concept of “delayed prescribing of antibiotics” — a recent study published in British Medical Journal (March 2014) found that, for patients with viral URI symptoms and a desire for antibiotics, giving them a delayed antibiotic prescription resulted in "fewer than 40% of patients using antibiotics,… less strong beliefs in antibiotics, and similar symptomatic outcomes to immediate prescription"!
October 21 2014, 8pm
I wanna see pictures of your lowest moment from 2013 go
I was in a Toy Story play.
And I loved it.
You’re an inspiration to us all
please explain how this was your lowest point
October 21 2014, 6pm
“chuffed doesnt mean what you think it means”
it means exactly what i think it means its just some stupid word that literally has two definitions that mean the opposite thing
This makes me really chuffed.
This post is quite egregious
Well I’m nonplussed by this whole post.