Needless to say when a headline story attacks my profession, I pay attention. Today, an article posted in Motley Fool about “Common Misdiagnosis” has me riled.
I have many problems with this article but I want to focus on that one–that Number One. The author quotes the journal Pediatrics. Here, doctors were reportedly polled and revealed that over 50% of physicians “improperly diagnosed a viral infection as a bacterial one in the last year.”
Sorry, I just don’t believe that.
I do not believe doctors actually misdiagnosed infections that many times. What I believe actually happened is that doctors were treating what they know are viruses with antibiotics. Antibiotics they know won’t work. They didn’t misdiagnose, they misprescribed.
It is quite simple actually.
We doctors acquiesce to patients who demand antibiotics. Then, in some twisted mental game we play, we NAME a bacterial infection. We do this to justify—to no one in particular–why we have prescribed antibiotics.
For example, I see a patient with a cold. I feel pressured to give the patient an antibiotic. Instead of owning what I am doing truthfully: “Diagnosis: Cold Virus, Treatment: Zpak, ” I name the cold a “sinus infection” or “bronchitis.” I do this because of an inherent need to explain, at least in my medical record, what I know to be bad prescribing habits. On many occasions, I have felt downright embarrassed speaking to a local pharmacist to phone in a Z-pak. I know she knows I am most likely doing the wrong thing. She understands that in the middle of July the likelihood of an outbreak of some bacterial illness is low. So, if we are all so knowledgeable about the futility of antibiotics in viruses, why does the ” Here’s-a-zpak-for-your-cold” fiasco continue?
The following is a post I wrote a month ago after feeling beaten down over this very issue. It is so timely today that I thought I would share it again.
Facebook Post June 2013
23,000 views, 153 shares, over 50 comments.
Can we please have a conversation about antibiotics?
I need you to hear MY side.
I am sure I speak for many doctors when I express frustration about this topic. It seems that patients and their doctors are at war when we should all be on the same side.
First, let me say that when an average sick visit is scheduled for 15 minutes it is easier to just prescribe the antibiotics then to explain why they are not necessary. Second, we prescribers have NOTHING to gain by withholding antibiotics. We are not rewarded in some way financially or otherwise. We are not trying to drum up another visit and copay. We are simply trying to practice sound medicine.
We are SCREWED when it comes to antibiotics in this country. In fact, there are some theories out there that for the first time in HUNDREDS of years, people are once again dying from infections that should and could have been cured a few years ago.
That is because we have given the antibiotics over and over and over again when they were not needed. Our societal bacteria against these antibiotics and now many are not even phased by antibiotics that once did them in.
Our pharma companies are not spending a dime developing new antibiotics because there is no money in them. They would rather come up with the new weight loss, diabetes, or cancer drug (not that those are not important.)
So, we have a handful of antibiotics that are no longer working. We have dozens of superbugs that are barely treatable. And we have a culture of patients that want antibiotics and doctors that want happy patients. It is a bad bad scene.
Further, antibiotics are NOT absolutely safe.
Here is a hypothetical situation (but very realistic.) A patient sees their doctor for sinus congestion and cough. They have been sick for 3-4 days. They are sure it is a sinus infection. They are leaving on vacation and just “can’t be sick.” The doctor knows that a sinus infection takes TWO WEEKS to develop, that right now, this is likely viral. But, because she does not want her patient to be unhappy, she prescribes the antibiotic. A few weeks later that patient develops C. Diff colitis (an infection caused by antibiotic use.) or tendonitis (a consequence of some antibiotics) or one of the dozens of other possible side effects of the antibiotic.
Now, we have done it.
1. The virus is better because it will just get better on its own.
2. We have put out there another antibiotic for superbugs to become resistant to.
3. We have caused our patient an ENORMOUS and potentially devastating problem by giving a drug they did not need.
We must have a conversation in this country about this disastrous situation we have gotten ourselves into.
Patients need to be educated about the diagnostics we use to determine if an infection is in fact bacterial. Doctors MUST take the time to explain the reasoning behind the “non-prescribing” AND stand their ground even if risking patient satisfaction.
I want to be a beloved doctor. I want all of my patients to feel satisfied with their treatment. But, my instant gratification comes at a very very high price….especially for my kids and their bacteria laden future.
Have you had a near miss with an infection or suffered the side effects of antibiotics? Are you a doctor feeling pressured to prescribe antibiotics? Please share.