medicine, primary care

Why I won’t just "call something in."

I often get calls from patients, either during office hours or while on call, requesting that I “call in a prescription.” It is usually a request for antibiotics.  Usually, the message is something like this.  “Hi, this is So and So.  I’ve has a cold for a week and I’m coughing up green stuff.  Can Dr. Nicholas just call in a Z-pack for me? It always works.  I’m  too busy at work to come in for a visit/don’t want to pay for an office visit/in Florida on vacation and can’t come in.”  Or it’s “Hi, I think I have a bladder infection.  Can Dr. Nicholas just call in something for me?”

The answer to these questions, invariably, is no.  Here are the various reasons why.

1.  There’s an almost 100% likelihood that your cold is viral.  That means that antibiotics will not do anything for it, other than give you a yeast infection or antibiotic-associated diarrhea.  The reason that the Z-Pack “always works” is because the cold would have gotten better on its own.

2.  If your upper respiratory infection is not viral, I need to figure out what it is.  Is it sinusitis (which usually doesn’t need an antibiotic!)?  Is is pneumonia?  Different antibiotics treat different bugs.  It’s not one size fits all.

3.  Maybe it’s not an infection at all.  People mistake allergies and asthma all the time as a “cold” or “bronchitis.”

4. More often than not, my patients who have self-diagnosed themselves with a UTI don’t actually have one.  I’ve seen sexually transmitted infections, kidney stones, bladder cancer, and even acute liver failure in people who were convinced that all they had was a UTI.

5.  Antibiotics need to be treated with respect.  They are horribly overused and we are paying the price with antibiotic resistant infections. If you are sick enough to need an antibiotic, you are sick enough to need to see a doctor.

6.  It’s just plain bad medicine to treat a patient without seeing and examining them.  So much is gained just by laying eyes on someone.  I can’t tell you how many times I’ve “forced” a patient to come in for an evalution- only to know within about 10 seconds that they need to be in the hospital.

So, patients, I’m not trying to annoy you.  I’m not trying to waste your time.  I’m not trying to rake in the big bucks from an office visit.  All I am trying to do is provide top-notch care.  I want the best for all of my patients.

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