Tuesday, January 8, 2013
Trying to do right
Winter is officially here and we are in the cold and flu season. This is the time that patients get sick with viral illnesses and primary care doctors get even more frustrated as they try to do the right thing for patients. What is the right thing?
First of all we want to relieve suffering. But we also want to do that without causing harm. We want to practice the best evidence-based medicine. And evidence shows us that antibiotics and extra testing does not help the time course of a virus. In fact, overuse of antibiotics drives drug resistance, increases the overall cost of health care and causes unintended side effects.
I've seen comments on the internet that doctors are part of the "business of medicine" and they order tests and use "big pharma" drugs so they can "make money." Well, folks, primary care doctors make no money ordering tests or prescribing drugs. Zero! In fact, it actually costs us money to do both. Blood and imaging tests (X-rays) require documentation, follow-up, time informing patients and can even lead to more testing if something is "borderline." We don't get a dime for this time consuming work that occurs after the patient is long gone from the exam room.
But even with the extra time it takes to order and follow-up on tests and order prescriptions, it takes even more time to explain to a patient why these things are not needed for a viral illness.
Believe me, I get it. I know how miserable a virus makes you. I know how nights are worse and how hard it is to sleep with a sore throat or congestion. I also understand the false hope that taking a pill will make it all better in a day or two. I know we all want instant cures. Here is how a typical scenario goes, usually on a weekend phone call:
Patient: "Doctor, I really need to be on an antibiotic. I get sinus infections every year and I'm congested now and last night my throat was burning and I couldn't swallow and I couldn't sleep all night long and I just know this will turn into a sinus infection because I get them every year and I need something called in right away because I have to go to New York on business on Thursday and I just can't be sick."
This phone call will take about 20 minutes because I will get more details and then explain, as kindly as I can, that this illness will probably last 7-10 days no matter what we do. I will offer my suggestions for comfort care, rest, pain relief and natural healing methods and the opportunity to re-evaluate if things get worse.
At the end of this phone call, the patient is usually frustrated and may be even angry with me because they really don't believe what I have said and they really do feel miserable.
This scenario plays out multiple times, day in and day out during the winter season. Sometimes I just give in and prescribe the antibiotic. I can only try to do the right thing so long.
This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: antibiotics, common cold, Everything Health, flu, guest post, patient communication, primary care, Toni Brayer
posted by Toni Brayer, MD at
9:00 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs,
MD
Albert Fuchs, MD, FACP, graduated from the
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also did his internal medicine training. Certified by the American
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full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical
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of Medicine, charter class of 2015, in Rochester, Mich., from which
she which chronicles her journey through medical training from day
1 of medical school.
Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and
general internist in the Division of General Internal Medicine at
Johns Hopkins. His research interests include doctor-patient
communication, bioethics, and systematic reviews.
Controversies in Hospital
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Run by three ACP
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and control, inside and outside the hospital. Daniel J Diekema, MD,
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hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating
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DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
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Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
Discovery at the Pritzker School of Medicine for the University of
Chicago. Her education and research focus is on resident duty
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
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David L. Katz, MD, MPH, FACP, is an internationally renowned
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Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of
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KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
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MD
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Michael Kirsch, MD, FACP, addresses the joys and challenges of
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Elaine Schattner, MD, FACP, shares her ideas on education, ethics
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Alexander M.
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More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice
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David M. Sack, MD, FACP, practices general gastroenterology at a
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musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections of a Grady
Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka,
MD, ACP Member, is a board certified rheumatologist in St. Paul,
Minn. He was a chief resident in internal medicine with the
University of Minnesota and then completed his fellowship training
in rheumatology in June 2011 at the University of Minnesota
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technology in medicine.
Technology in (Medical)
Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
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management.
Peter A. Lipson,
MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
around in various forms since 2007, offers musings on the
intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice
Boughton, MD, FACP, practiced internal medicine for 20 years before
adopting a career in hospital and primary care medicine as a locum
tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical
Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
commentary and more.
Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS Blog
The Public Library of Science's open access materials include a
blog.
White Coat
Rants
One of the most popular anonymous blogs written by an emergency
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