Doctor’s #1 Most Common Misdiagnosis: Infection?

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.

Why?

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.

 

Comments

  1. Doc Shannon says:

    Loved it then. Love it now. I know I have lost clients to my unwillingness to prescribe antibiotics for upper respiratory infections – all to common in cats as being totally viral. I always tell them to watch for signs of secondary bacterial infection and that if those signs develop we can then start antibiotics. Thanks again Dr. Meyer. This one is being shared o n my clinic page.

  2. Ellen W. says:

    As you know I recently suffered a horrible bout of C-Diff brought on by a very commonly prescribed antibiotic, clindamycin. I was prescribed this antibiotic for a lingering sinus infection and within days I was sicker than you can imagine. No one wants to end up with C-Diff…if you’ve never had this illness you are very lucky. You end up with the most painful case of diarrhea than you can imagine, and this can go on for weeks or even months. And the pain! Stomach cramps you wouldn’t wish on your worst enemy, by the time it’s over you are so weak, you can’t remember what’s good felt like. So, my advice to anyone looking for and antibiotic to be prescribed…think again! Weeks later im still 12 lbs. down (that should give and idea of how sick i was). it has taken me weeks to get back to eating normal food, to get my strength back. I finally got rid of the original sinus infection (and no I didn’t ask for it) but paid a very high price for the privilege. I’ve been told that I will always have to be extra vigilant about taking antibiotics in the future, I have a new respect for these powerful drugs. They have their place but that’s for the doctor to decide. As for asking my doctor for an antibiotic, I can’t imagine having the nerve! Aren’t we there, in their care so that we can avail ourselves of their expertise? I’d rather put my trust in my doctor than assume that I know more than she does.

  3. Marlene says:

    I can totally understand the pressure that some doctors feel to give that piece of paper to the patient to bring to their pharmacy. The patient holds that prescription and believes that soon everything will be better and that they can get on with their life and their schedule of events. I feel sorry for the doctors being put under so much pressure. However, I for one would rather have my doctor examine me and say that in a particular situation that antibiotics would not help and why they would not help rather then to give me a prescription for a medication that is in a particular situation – useless. Please don’t let us patients bully you into prescribing what we really don’t need. Just tell us in your usual kind way that we just have to ride out the situation. If prescribing something for the symptoms like for a cough or stuffiness would help, well then I for one would appreciate that. Stand in your truth and we will respect you even more for doing that. Patients who don’t understand and who try to bully you are just not worth having a partnership with. All the best, Marlene

  4. Anonymous says:

    I was mis-diagnosed with a UTI infection and given Bactrim. A few minutes after taking Bactrim I had a severe reaction, throat swelling, hives, etc. I then went to the Allergy Dr. to test for other Antibiotics that I may be allergic to. Turns out I am alergic to Bactrim, Cipro, Amox & Penicillian. I am NOT a fan of antibiotics unless I absolutely need them.

  5. The pendulum has swung too far in the other direction. Docs are now scared to Rx an antibiotic. Just like treating a virtual infection as bacterial is bad, treating a bacterial as viral is bad. It’s all about balance.

  6. I have been sick for over a month now. No fever but my throat has showed the same swelling and white spots as strep (tonsils were removed long ago) sinuses inflamed, excess mucus production, and most worrisome, a golf ball sized hard, painful, lump on my upper left rib cage. 1st Dr threw amoxicillin at it and dismissed the lump all together. 2nd Dr (a month later) did the same thing saying, and I quote, “Must be an infection” no more info, once again dismissed the lump. Today 3rd Dr (emergency room due to pain in side) actually ordered a CT with contrast of just my torso from collar bone to just below my navel, ordered a UA, and blood work. Comes in and says he felt no lump (although the the nurse did) and he sees nothing on CT and no signs of infection in blood work. His best guess is virus. I didnt argue knowing antibiotics don’t fix viral infections, didn’t ask for pain meds either. Left still in pain and utterly baffled… At least Dr #3 didn’t just throw antibiotics at me… Starting to think I’m just crazy.

  7. Jennifer A Mueller says:

    This isn’t very cozy as I had staph in my face a year ago but wasn’t able to get it swab due to the clindamycin cream that I was told would give negative results. At the time I was seeing a dermatologist that I don’t think really knew what was going on and I ended up in the ER with my whole lower chin swollen up.
    I get infections that last for several months and they’re always infected regardless of my massive bottles of peroxide and rubbing alcohol and antibacterial soaps. Neosporin then prescribe stronger type Neosporin and none of it works. After several doctors iand dermatologists with no answers I gave up. I was always told anxiety and that I won’t leave it alone. I would leave it alone if it would actually go away. Apparently I’ve had anxiety my whole life so why would it now be the reason why I have sores when I didn’t have them before. I did my own tattoo years ago and was probably a little sloppy about cross-contamination at my table. Being a rookie I dug my needle too deep and then thought it was smart to wrap it with plastic before I went to a dirty job. My foot all the way past my knee was extremely swollen and I never went to the doctor because I didn’t have insurance. I always thought that was when the infections really took off around my entire body popping up wherever it felt like. Brought it up to all my doctors but then they blow it off like it has nothing to do with what’s going on now but I don’t know if that’s true.
    Now a year later I have swollen lymph node in my neck and a bad infection on the outer ear of the same side as the lump in my neck. My infections Trail each other leaving scars. I also have been dealing with ones popping up on the back of my neck eventually healing after months and then it just reappears in the same spots. I have extremely bad dizzy spells almost on a daily basis but never completely blacked out. There are many days where I feel a little green all the way down to my bones but never enough to really take me down. Not sure if it’s my job or not in HVAC but I’ve lost a good 15-20 pounds pretty quick. I am 44 soon and I haven’t been a 145lb. Since before I gave birth to my son at age 33.
    Now I’m going to a different clinic so hopefully they get it figured out because this website scares me.

  8. For the past decade I have been battling recurring sinus infections. I have taken hundreds of prescriptions of antibiotics. I found out last week that I have been actually dealing with migraines. This is after 6 ENT’s and about 10 general practitioners…antibiotics only masked the problem. And have been thrown so many that it’s not even funny at this point. Great post.

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