Blog | Tuesday, May 17, 2016

Best practices, and when your doctor says no


The American College of Physicians and the Centers for Disease Control and Prevention give guidelines (known as high-value care advice) to physicians based on the best current scientific evidence. Physicians try to treat patients based on those guidelines even when patients want a different treatment. Here are three that create the most problems when physicians try to do the right thing.
No antibiotics for acute bronchitis. Acute bronchial bronchitis can last up to 6 weeks with a purulent or dry cough. It is one of the most common out-patient diagnoses we see. More than 15 excellent scientific studies show no benefit in treating with antibiotics and a trend toward adverse complications when antibiotics were used. All primary care physicians and emergency department physicians experience the constant request for Z-Pac throughout the winter. “It helped my friend, family, kid.” “It's the only thing that works for me.” It is hard to see a suffering patient who wants to be helped and resist the request. That is why 70% of patients with acute bronchial bronchitis get an antibiotic.
No antibiotics for pharyngitis unless testing positive for strep. Only 15% of acute sore throats are caused by bacterial infections. The remainder are viruses that do not respond to antibiotics.
No antibiotics for acute rhinosinusitis, aka sinusitis. More than 4.3 million adults are diagnosed with sinusitis annually and 80% receive antibiotics despite the fact that it is usually a self-limited illness caused by a virus, allergy, or irritant that causes inflammation in the tissue in the nose and sinus cavity. A bacterial cause usually lasts longer than 10 days and is associated with fever.

Doctors are often put between a rock and a hard place if they follow evidence-based guidelines. We want to please patient and help them, and when we don't, patient satisfaction scores go down. But some studies are showing that doctors who offer symptomatic relief and take the extra time to explain why antibiotics are not needed can still get good survey scores.

According to the Annals of Internal Medicine, reducing inappropriate antibiotic use will improve quality of care, decrease health care costs and preserve the effectiveness of antibiotics.

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.