There was an excellent article in the New York Times today entitled, “Why Doctors Order So Many Tests.” I encourage everyone to check it out, along with the comments.
Those of you that are my patients know that I try to take a pretty minimalist approach to testing and medications. I encourage people to make lifestyle changes before taking medications, if appropriate. I do not encourage so-called “screening” tests unless they are recommended by the USPTF. For example, I’ve spent plenty of time trying to convince patients that they don’t need a full body CT scan and that certain women don’t need a Pap smear every year. Some people take my advice, some don’t. And that’s fine. All I can do is make recommendations based on my expertise. After that, it’s up to the patient. They are the steward of their own health, and I have no problem with that.
One of the toughest things I have to do is convince people that antibiotics are not needed for a self-limited infection. This is one thing that I do not cave on- no one can force me to write a prescription that I don’t feel is indicated. However, I can’t stop someone from heading over to the ER or urgent care center. Nothing frustrates me like telling a patient that they don’t need antibiotics for their bronchitis, and then having them go to the ER a day later and be given a Z-Pack. This will typically be followed by a phone call from the patient saying, “You wouldn’t give me an antibiotic and I had to go to the ER. I took the Z-Pack and I was better in a week.” My response to this- you would have been better in a week anyway, with or without an antibiotic.
Please, I beg of everyone- try to think of antibiotics as a life-saving treatment that is reserved for a serious infection. Our armamentarium is limited, and over-prescribing of antibiotics has the real potential to put us back in the pre-penicillin days. That is a scary, scary thought.