Sunday, March 20, 2016

Best Practices and When Your Doctor Says No

The American College of Physicians and the Centers for Disease Control 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 six 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 Strept) 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 them 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.


Raymond Bouchayer said...

I remember when growing in France that antibiotics were only given as a last resort .It seems that here in the US the patient expect to be given these drugs at the first sign of a cold or minor infection.

Anonymous said...

I get acute bronchitis 4 times a year, at minimum. I go in to see my doctor because of accompanying asthma problems. He always gives me antibiotics. The two times I said screw it, I'm not taking the antibiotics I got pneumonia. I think I'll stick to the antibiotics, but I wouldn't assume that my partner or kids needs them just because I am taking them and we're sick with presumably the same thing.

Myezpharmacy said...

I totally agree with your opinion about this topic. I hate to eat tablets unnecessary. Thanks for your guidance.

Elisa Kits said...

No matter what you do in life, I have always thought if a professional give you some advise in their specialist field, listen to them. they have more often then not been working, or studying in that specific field all their life so they would definitely have a better idea then you. Unless you are also a professional in the field that is!