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Old 12-09-2012, 03:23 PM
 
787 posts, read 1,500,820 times
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It's that time of year, again: when every person that comes to my office with a simple cold/cough wants an antibiotic. As a doctor, I've come to dread these visits. I know that most of these illnesses are viral (thus antibiotics will not work) and that they will go away on their own with time. It seems no amount of attempting to educate/convince my patients will do for about 30% of patients. Taking an antibiotic when you have a viral infection is like taking a placebo--except that you could get adverse effects from the antibiotic (like when people end up growing the potentially serious "c diff" bacteria in their colon due to killing the "good bacteria" in the gut) and the antibiotic may not work when you actually need it (like the people who may end up needing to be hospitalized for IV antibiotics for a urinary tract infection because the bug is resistant to regular antibiotics). There's obviously a role for antibiotics for some upper respiratory illnesses, but not most--this is where seeing the doctor can help. We can decide whether it is a bacterial infection and thus warrants an antibiotic. I'm getting weary of the struggles to protect people from themselves, only to have them become demanding, rude, and confrontational. I'm tired of people saying "I can't afford to be sick!! I'm a busy mom/executive/xyx, or I have a big vacation planned! I want to try the antibiotic!!! THAT'S the only reason I came here today!!!! Now I've wasted my time!". As a doctor, I totally "get" being too busy to be sick or not wanting to be sick on vacation, but when I'm sick, I deal with it the same way I ask my patients deal with it.
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Old 12-09-2012, 03:46 PM
 
Location: Maine
2,274 posts, read 6,014,591 times
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I know -- people demand all kinds of medications that they don't need, especially antibiotics. We in this country feel entitled to whatever treatment we want -- whatever specialist, trendy medication.
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Old 12-09-2012, 04:53 PM
 
Location: Mostly in my head
19,867 posts, read 59,169,758 times
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True except that I am diabetic with a partially blocked sinus cavity. When I get a virus I inevitably get a bacterial sinus infection. My ENT believed me after a few times and would prescribe a/b. The walk-in clinics are a waste of time as they don't know me.
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Old 12-09-2012, 04:55 PM
 
Location: Canada
4,739 posts, read 8,998,341 times
Reputation: 5084
Quote:
Originally Posted by 55degrees View Post
It's that time of year, again: when every person that comes to my office with a simple cold/cough wants an antibiotic. As a doctor, I've come to dread these visits. I know that most of these illnesses are viral (thus antibiotics will not work) and that they will go away on their own with time. It seems no amount of attempting to educate/convince my patients will do for about 30% of patients. Taking an antibiotic when you have a viral infection is like taking a placebo--except that you could get adverse effects from the antibiotic (like when people end up growing the potentially serious "c diff" bacteria in their colon due to killing the "good bacteria" in the gut) and the antibiotic may not work when you actually need it (like the people who may end up needing to be hospitalized for IV antibiotics for a urinary tract infection because the bug is resistant to regular antibiotics). There's obviously a role for antibiotics for some upper respiratory illnesses, but not most--this is where seeing the doctor can help. We can decide whether it is a bacterial infection and thus warrants an antibiotic. I'm getting weary of the struggles to protect people from themselves, only to have them become demanding, rude, and confrontational. I'm tired of people saying "I can't afford to be sick!! I'm a busy mom/executive/xyx, or I have a big vacation planned! I want to try the antibiotic!!! THAT'S the only reason I came here today!!!! Now I've wasted my time!". As a doctor, I totally "get" being too busy to be sick or not wanting to be sick on vacation, but when I'm sick, I deal with it the same way I ask my patients deal with it.
I feel you man! I'm a pharmacy student in British Columbia, Canada and our order has a big, heavily advertised public education campaign going on right now called "Do Bugs Need Drugs?" It's so high profile that I hope it'll be able to combat some of these issues. Perhaps you could advocate within your local professional order for something similar should our campaign actually have the intended effect. Here's the website:

A Community Program for Wise Use of Antibiotics | Do Bugs Need Drugs?
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Old 12-09-2012, 05:02 PM
 
Location: stuck in the woods with bears and moose
22,340 posts, read 21,425,152 times
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I've never demanded an antibiotic and I think most people know all about the adverse effects and to not take them unless absolutely necessary. But when I've got a sinus infection and am in pain, am weak and exhausted, have tried neti pots and decongestants and I STILL HAVE A SINUS INFECTION, do I have to beg?

I finally got so sick that my husband had to carry me in all because the doctor wouldn't believe me. My previous doctor KNEW that I got a sinus infection every winter and there was never a problem. Just don't paint us all with the same broad brush.
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Old 12-09-2012, 05:12 PM
 
5,587 posts, read 11,777,836 times
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Quote:
Originally Posted by in_newengland View Post
I've never demanded an antibiotic and I think most people know all about the adverse effects and to not take them unless absolutely necessary. But when I've got a sinus infection and am in pain, am weak and exhausted, have tried neti pots and decongestants and I STILL HAVE A SINUS INFECTION, do I have to beg?

I finally got so sick that my husband had to carry me in all because the doctor wouldn't believe me. My previous doctor KNEW that I got a sinus infection every winter and there was never a problem. Just don't paint us all with the same broad brush.
What are you basing your assumptions regarding "most people" on???

Clearly, facts state otherwise. MANY, MANY people walk into offices every day demanding antibiotics for their "colds" as already pointed out by the OP.

I also don't understand about your husband "having to carry you in" as if that is a bad thing? Were you upset that a physician wouldn't prescribe antibiotics over the phone WITHOUT seeing you? In 20 years of practice I have never called in an antibiotic without actually seeing the patient.
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Old 12-09-2012, 06:49 PM
 
Location: In a house
13,253 posts, read 38,607,235 times
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It's a circular myth.

It used to be, doctors would automatically prescribe antibiotics for anyone coming in with severe cold symptoms, or a sore throat. They'd take a culture, and send you home with the scrip, and you'd take the antibiotics for a few days, and then they'd call you back and let you know whether or not you actually needed them to treat strep throat.

Then, they learned that auto-treating with antibiotics isn't such a hot idea afterall. But by that time, many people were so used to it, that they'd go to the doctor expecting the prescription, and would be upset when they didn't get it. Because they were taught for all those years that it was necessary.

Now, it's a mixed bag. There are still segments of the population that are convinced that antibiotics are the appropriate treatment for severe cold symptoms and sore throats, and infections of all kinds, including bacterial, viral, and even fungal. And there are still physicians who are a little too eager to prescribe them as a "just in case."

I'm all for taking antibiotics to treat known bacterial infections, and if I was sick with something that was clearly severe - as in, coughing up blood, difficulty breathing, heart palpitations, dizziness, brain-shattering pain - I'd probably feel very comfortable in taking antibiotics even without a diagnosis, as a "just in case." If I was at-risk, I'd be fine taking a course of them prior to dental surgery too. I'm not at-risk - but I understand the implications of it.

Other than that, I don't see any reason to take them, and so I don't take them for any other reason.
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Old 12-09-2012, 09:19 PM
 
787 posts, read 1,500,820 times
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Quote:
Originally Posted by SouthernBelleInUtah View Post
True except that I am diabetic with a partially blocked sinus cavity. When I get a virus I inevitably get a bacterial sinus infection. My ENT believed me after a few times and would prescribe a/b. The walk-in clinics are a waste of time as they don't know me.
True, some people/cases are exceptions (like you)....problem is that a very large number of people think they are exceptions when they're not.

Quote:
Originally Posted by in_newengland View Post
I've never demanded an antibiotic and I think most people know all about the adverse effects and to not take them unless absolutely necessary. But when I've got a sinus infection and am in pain, am weak and exhausted, have tried neti pots and decongestants and I STILL HAVE A SINUS INFECTION, do I have to beg?

I finally got so sick that my husband had to carry me in all because the doctor wouldn't believe me. My previous doctor KNEW that I got a sinus infection every winter and there was never a problem. Just don't paint us all with the same broad brush.
No, most people won't only take them when absolutely necessary. I had multiple people this last week who had only TWO days of mild symptoms and still wanted an antibiotic because they couldn't "afford to be sick" or didn't want to be sick because they were going on vacation, going to a wedding, etc. These are very well educated people actually. They don't mind rolling the dice if there's a chance they will feel better immediately. Also, they haven't yet had to deal with a resistant bug.

Also, since some people brought up sinus infections... I know there are people who have bacterial sinus infections, but a majority of sinus infections are viral. There are a few things we look for that would point us toward a bacterial cause (and thus toward prescribing an antibiotic). This is a nice website with more info Acute sinusitis (sinus infection)

Jeez, my life would be much easier if I just prescribed antibiotics to everyone who asked for them (this is exactly why a lot of doctors do prescribe a lot of antibiotics). I really try to be give people what they want and be agreeable, but I can't really do that with antibiotics...."first, do no harm"
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Old 12-09-2012, 10:57 PM
 
2,540 posts, read 3,699,069 times
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I've actually had the opposite problem - doctors way too eager to prescribe a/b for ailments that don't seem to need them, including for a young child. They give you the script right off, and then when I explain that I have a very sensitive stomach (irritable bowel) and do NOT want to take chances of digestive upset side effects unless it's absolutely necessary, they go 'well, you'll most likely be okay with just waiting it out, but in case you don't see improvement in such-and-such time, you should start them". Well, why not just say that right away, and possibly avoid taking unnecessary drugs that'll wreck havoc on my system??
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Old 12-09-2012, 11:19 PM
 
26,507 posts, read 33,827,507 times
Reputation: 23893
I don't visit a doctor unless I need my thryroid script renewed. The other time is if symptoms last longer then a week.
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