Antibiotic wars and woes

[Aunt Val]

Had a frustrating patient interaction today that led to a frustrating interaction with a coworker.  I know you all deal with this stuff too . . .

Patient who did not need abx demanded abx.  I tactfully refused, explaining my reasoning and suggesting alternate OTC tx to help mitigate symptoms while her body fights off the viral infection.  Pt argued, got upset, and demanded to see someone else who would give her abx because she didn't come in to pay all this money and not get the medicine she knows she needs.

So I walked out and went to talk with my MD colleague.  Explained that I had made a patient mad and she was demanding to see someone else.  I explained the situation and asked if he would please help me out.  He agreed and said that my medical reasoning was perfectly correct -- but that he would go clear things up and give the pt abx anyway!

Me:  "But that's terrible medicine!"

MD:  "It's terrible medicine to upset patients, too.  They might report us to the medical board.  And what's the worst that could happen if we give her an unnecessary antibiotic?  A bit of a yeast infection?"  (This doc has been reported to the board by an angry patient before, completely unjustly from what I understand of the case, and it was a traumatic experience for him.)

Me:  "Doc, if you're going to see her as your patient, then you can treat her however you see fit, but I'm still not giving her any antibiotics."

So he went and prescribed the patient some antibiotics for her virus.

This is the third or fourth time that this (older, experienced) MD has done something like this to me.  He's a smart guy, friendly, and always open to me asking questions about stuff I don't understand or have much experience with.  I've learned a lot from him since I started working at this clinic, and I have a lot of respect for him overall.  But it's just so frustrating when he tells me I'm right but refuses to back me up.  Ugh.

[Reality Check 2]

There is no excuse for BAD Medicine.

Patients are patients - not customers.

Science is not negotiable.

This doc is doing so much more harm than good.

UGH!

[ventana]

He is training the patients to split staff.  
nope 

I would put a not in that patients chart that you prefer not to see them.  He created the monster. He can have them.  
 

if you are an old crusty PA just refuse to play the game.  
 

I would never let another doc into the exam room for a patient I just saw.  You don’t like my assessment then go to front desk.  

[rev ronin]

Good Press-Ganey scores mean more patients die unnecessarily.  If you can't learn to say "no" politely and make it stick, learn:

"The harms outweigh the benefits. If you like, I can send you medical literature on this."

"I'm aware you've gotten antibiotics for your URIs for the last 20 years. That doesn't mean it was the right thing to do, just that nothing terrible has happened yet, other than you wasting your money and maybe getting some avoidable diarrhea."

"There are some non-antibiotic things we can try that will likely make you feel better sooner."

ETA: As far as the doc throwing you under the bus and caving? I'd consider reporting him to the medical board.  Not really, but this doc has a multilevel missing vertebrae problem.

[Mayamom]

19 hours ago, Reality Check 2 said:

Patients are patients - not customers

But they are.....in the people who manage the profits we make for them. 

[Mayamom]

This has been happening for decades.  I practiced in a very busy pediatric office.  Mother  came in saying Doc always gave her child antibiotics.  I stressed she did not need them.  I called same doc he talked me into giving this child antibiotics & he would see the patient in follow up.  Patient came back with Steven Johnson's Syndrome.  So dam frustrating.  It's just the easier path to hand them out.  Not saying is right....

[sas5814]

Let me give you a flip side that absolutely blew my mind. I am in the VA burn pit registry for chronic sinusitis x 30 years. Its a long story but I am chronically congested and blow blood for a few days every month. I have seen ENT, had surgical intervention, use 5 different meds to try and manage it along with frequent saline washes ala Neti Pot.

Service connected yes. Rating 0%. The main reasoning? No record of frequent infections requiring antibiotics.

This isn't the first time the VA has punished me for not flooding my records with useless visits and treatments.

[kettle]

I explain that antibiotics have side effects like cdiff. Explain that can cause 15-20 loose stools a day, that it maybe refractory to standard antibiotics and then we have to give them a very expensive oral antibiotic called vancomycin and if that doesn't work they have to get a fecal oral transplant of someone else's feeces. At that point they decide symptomatic treatment is the better option. Something about having to possibly take someone else's feeces is the deciding factor 

[CornellSPA]

I always tell patients "You don't need antibiotics... its HAMMER TIME!" and I give them the attached article on the vitamin D hammer for viral infections ( a one time 50,000 IU of D-3) -- as I put the article in their hand I'd say about 80% of people are pretty excited about it...safe...effective...cheap...great data behind it etc 

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/pdf/0610507.pdf