Comments on: Do (nothing)

By: hwong14

hwong14 — Tue, 02 Dec 2008 21:56:15 +0000

I got so frustrated this past spring when, for the first time, I spent a large amount of time in a private practitioner’s office. Good lord, the amount of unnecessary medicine he would give out! I was shocked! Appalled! And then I realized the truth you mentioned: to be a good businessperson, you have to keep your customers happy. And sometimes that is at odds with what your medical training would have you do. I’m still uncomfortable with it, not sure how I’m going to handle it, kind of happy I have all of residency to keep trying to figure it out.

And tomorrow, the tables will be turned: I am bringing my cat into the vet, because she has some goopy eye discharge. A virus, I’m sure; not even conjunctivitis. But she’s a cat, and I may be 5 months from my M.D. but maybe, just MAYBE there’s something I don’t know about cats and colds, so off to the vet we go. I’m already gearing myself up for, “It’s a virus, there’s nothing to do for it.” It’s still going to suck, I know.

By: Dan

Dan — Thu, 27 Nov 2008 00:06:31 +0000

Then there is the placebo effect:

Placebo is a latin word which means, ‘I will please’

A patient who presents with symptoms that are not in correlation with their concerns may be candidates for a placebo from their healthcare provider. The patient may accept and ingest the placebo, and through the power of suggestion along with the subjec-expantacy effect, the patient may have their symptoms altered or eliminated due to the patient’s beliefs and expectations.

Everyone wins, and the health care provider ‘pleases’ the patient.

Dan Abshear

By: Rob

Rob — Mon, 24 Nov 2008 03:18:59 +0000

John: Thanks for the resources. I have seen some of that stuff. To be truthful, this post was simply me venting about the dilemma I face every day and the pressure itself. I rarely prescribe unnecessary medications, even with demanding patients. I have found ways to explain and to try to help them feel better. I just wanted to give the emotion that doctors feel – that is one of the main purposes of this blog. It is not the whole picture.

Amanda: Nothing is worse than normal. I don’t mind people coming in for things that end up being viral. I would rather have people come in for milder stuff than to stay home for more serious stuff. As a mother you need to be cautious and listen to your intuition – it is often right.
But there is no way of knowing if your daughter really needed the medication. Your doctor did what many of us do. We care about our patients and understand the difficult situation they are in. It is our job to make them happy as well as to keep them healthy.

By: Amanda B

Amanda B — Mon, 24 Nov 2008 02:49:49 +0000

It’s so hard to know what to do. We had a very nasty virus running around that started out with body aches and a high fever (104 in ear), that my 3 yo caught. I was totally OK with not having an antibiotic, grabbing a doctor’s note and waiting it out. In less than 48 hours it turned into a double ear infection, tonsillitis, and sinusitis with the same fever. We then went home with an antibiotic that turned into two courses to get rid of the sinus infection. My daughter caught the same virus – I told the doctor what my son went through – and we left with a prescription – just in case. Of course I filled it and then gave it to her when it seemed to turn bad as his had. She was only sick three days, he was sick fourteen. Do viruses turn bad like that often? Or is it just that kind of year? Last year we struggled with Strep as did most of our small town.

By: John

John — Sun, 23 Nov 2008 19:37:10 +0000

Just a follow-up on my previous e-mail.

Our e-mail is
paact@mumshealth.com

NOT
paact@mumshealth.org

By: John

John — Sun, 23 Nov 2008 19:33:48 +0000

FYI – I have included just a few quick notes and suggested some tools (family practice friendly guidelines and NON-Antibiotic prescribing PADS) that might help Physicians, Patients and eventually society (through lowered antibiotic resistance rates).

1) In the early 1990’s a program began to curtail the over use of antibiotics and limit the spread of antibacterial resistant organisms. It was known as the PAACT program (Partners for Appropriate Anti-infective Community Therapy) and started in Port Perry, Ontario, CANADA (where we certainly see our share of colds and viral infections) under the leadership of a local family Physician Dr. John Stewart and research pharmacists Laurie Dunn and John Pilla.

2) The educational program used specially designed and user-friendly guidelines and a special prescription pads that DID NOT prescribe ANTIBIOTICS, but advice. ( see the website http://www.mumshealth.com for these and WALL POSTERS for Physician offices).

3) This program was replicated in many jurisdictions including Michigan, USA. The program was evaluated and published in peer-reviewed journals. The results showed a significant drop in the use of antibiotics.

We continue to promote and encourage others to get involved as we and many others no the importance of this issue.
If you need more information – see the website or would like to start a program feel free to e-mail us at paact@mumshealth.org.
Cheers and best wishes, John

By: ladyk73

ladyk73 — Sun, 23 Nov 2008 04:28:59 +0000

Please keep in mind that some patients may feel really stupid if they go to the doctor and there is nothing “wrong.” I know I sometimes feel ashamed for wasting the doctor’s time. So please validate are feelings that a bad cold can seem like the end of the world.

I know I always freak out because of my Asthma. I have had many of a cold turn into a bad bad asthma attack. So some of us may be steriod seekers.

By: mottsapplesauce

mottsapplesauce — Sun, 23 Nov 2008 01:49:26 +0000

Being the stoic person that I am, I generally don’t see my PMD unless the symptoms persist after taking the OTC stuff for several days, & with no signs of it getting better. Even at that, if it’s a nasty URI my Doc just prescribes expectorant capsules (the name escapes me), which have worked well in the past. I empathize with your frustration though. People tend to panic & it’s good to have a Doc that can offer reassurance, even if there’s no prescription to go with it. I imagine you have a few that insist on antibiotics, regardless.

By: GMH

GMH — Sun, 23 Nov 2008 01:03:08 +0000

I think patients want sympathy and the doctor’s reassurance that it is NOT a secondary bacterial infection. I also think a handout with homeopathic and over-the-counter remedies would be a good idea to make the client feel taken care of. One technique I have found to alleviate the pain of clogged sinuses is the use of a neti pot. Sore throat suffering is relieved by use of Chloraseptic or the generic equivalent. Zicam throat spray and nasal spray work wonders at alleviating symptoms and seeming to make the cold end sooner. You don’t agree with those I have listed? GREAT! Write YOUR recommendations for your patients and you have a winner of a handout.

One reason I sometimes see a doctor about an URI is that my friends keep pressuring me to do so. I am perfectly happy to have my doctor offer sympathy and send me on my way if it’s viral (which I already know it is). I am just getting over a URI and as usual I hear the same two things from friends:
1. go to your doctor NOW and
2. it is YOUR fault you are sick
Many of my friends think that sick people CAUSE their own illness due to working too hard, not washing hands enough, not having a positive enough attitude, not eating properly, not taking the right combo of vitamins, not exercising or sleeping enough, etc. Therefore another good thing to say to this stereotypical patient is “It is NOT your fault! I am seeing a lot of this right now”

By: James Hubbard, M.D., M.P.H.

James Hubbard, M.D., M.P.H. — Sat, 22 Nov 2008 21:50:46 +0000

I have seen a trend toward patients being more informed about viruses within the last few years. I am an optomist.