Doctors told to stop prescribing antibiotics for coughs and colds

[Matty1973]

"Experts at the influential centre, based in Stockholm which is focused on controlling infectious diseases in Europe, say the prescription of the pills, which are not necessary in most cases, is fuelling the rise in the number of infections that are resistant to antibiotics."

http://www.telegraph.co.uk/health/he...and-colds.html

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

[Dymanic]

I think that is a very clever idea.

[six7s]

Originally Posted by Matty1973

...so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Maybe...

But the doctors would first have to take the hypocritic oath:

do no good

[athon]

Originally Posted by Matty1973

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

In either case, it's avoiding the central issue. There is more to medicine than simply offering a pill.

The real reason alternative medicineis so popular is that it does two things - makes the patient feel in control of their own health, and connects them with other people who seem to be genuinely concerned for them as a person. The (non)science behind it is often more accessible to the lay person, provides (false) hope and arises from social thinking rather than the more harsh critical thinking of science. Importantly, practitioners often give more time to discussing the patient's anxieties and engaging with their emotional needs.

If a GP were to administer a homeopathic pill, I don't see it addressing the ultimate need of a patient. I know when I worked in an Accident and Emergency department of a hospital we'd often see the same patients come in who could be described as hypchondriacs.

Flipping another pill is simply not the way to deal with them.

Athon

[six7s]

Originally Posted by athon

The (non)science behind it is often more accessible to the lay person, provides (false) hope and arises from social thinking rather than the more harsh critical thinking of science.

Also... woo-ey family and friends are likely to be more sympathetic towards a patient who - in consulting a quack - is 'at least doing something'

[shandyjan]

It always surprises me, as never in my life, or with my children have any of us been given antibiotics for coughs and colds.

[The Fallen Serpent]

Some people are very insistent that they be given a cure once they have a doctor's attention.

[Jeff Corey]

Originally Posted by shandyjan

It always surprises me, as never in my life, or with my children have any of us been given antibiotics for coughs and colds.

Me neither. After dental surgery as prophylaxis, might have been unnecessary.

[Careyp74]

You shouldn't give homeopathic medicine for coughs and colds, you will increase the resistance to the placebo effect, too! Just feed a cold, or starve it, whatever.

[Miss_Kitt]

I am amazed when I hear about this, but I have had doctors I know in this skeptic community say that they were taught to dispense antibiotics if the patient 'really wanted something'. I regard that as highly irresponsible. The doctor may need to take the time to educate the patient a bit as to why their condition does not require prescription meds; and/or write a note suggesting OTC meds that may provide relief, so that the patient feels like they have "doctor's orders."

I would love to hear from medical practitioner here on the subject of whether they think it is ethical to give what you know is a useless antibiotic to a patient, just to avoid having to tell them 'No'.

[athon]

Originally Posted by Miss_Kitt

I would love to hear from medical practitioner here on the subject of whether they think it is ethical to give what you know is a useless antibiotic to a patient, just to avoid having to tell them 'No'.

To be fair, a lot of GPs don't give antibiotics for viruses simply as placebos, but rather to address actual or potential secondary infections.

Yet my opposition to this remains, given it's only in high risk groups do secondary infections really ever turn into anything nasty. In other words, even a bit of a resulting chest infection will typically fade within a week or so - only a little longer than if the patient had have attacked it with antibiotics.

Athon

[Matty1973]

Originally Posted by athon

I know when I worked in an Accident and Emergency department of a hospital we'd often see the same patients come in who could be described as hypchondriacs.

Flipping another pill is simply not the way to deal with them.

Athon

What do you think is the way to deal with them within the arena of public health care and do you think they currently receive that service?

Does a doctor have the right to say to a patient you have no physical problems - you have psychological issues? I can imagine that would be very difficult.

[fagin]

I once phoned my doctor with a really bad case of flu asking if anything would help. He suggested a shotgun was the only definite cure.

[Ethan Thane Athen]

My friend is a GP and this drives her mad. She tells patients they have a viral infection and that antibiotics won't help but they re-book to see one of her colleagues and they happily prescribe antibiotics. When she's tackled them on this they just shrug and say 'Well it keeps them happy and off my back.'.

What makes it even more annoying for her is that the patients then feedback to eachother and the practice that she's a rubbish doctor who 'Couldn't do anything' but 'Good old Doctor X sorted me out'.

She's actually wavered on occasion and considered joining in to avoid losing even more patients but has so far resisted...

[lomiller]

I suspect the use of those same antibiotics in agriculture is an even bigger problem. Otherwise, I tend to agree. Physicians should not be giving antibiotics speculatively, they should be targeting a specific condition and using the correct amount to resolve that condition.

I can see it from a doctors perspective though. Proscribing antibiotics is unlikely to harm their patient and may end up helping them while the damage done is externalized and not their responsibility.

[blutoski]

Originally Posted by Matty1973

"Experts at the influential centre, based in Stockholm which is focused on controlling infectious diseases in Europe, say the prescription of the pills, which are not necessary in most cases, is fuelling the rise in the number of infections that are resistant to antibiotics."

http://www.telegraph.co.uk/health/he...and-colds.html

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

I think there's a misunderstanding, though. Prescribing antibiotics for cold and flu remains appropriate for some patients, and the purpose is to reduce the risk of complications.

When you hear about deaths from flu the most common cause is pneumonia, which can be prevented with antibiotics.

My impression is that the overprescribing of antibiotics for cold and flu is MDs being overly cautious about opportunistic bacterial infections - not an attempt to administer a placebo.

[blutoski]

Originally Posted by Matty1973

What do you think is the way to deal with them within the arena of public health care and do you think they currently receive that service?

Hypochondria is not a diagnosis in and of itself.

Whether it's their first suspicious visit, or a return visit that shows a pattern, the emerg MD will have determined at some point that the patient has an exaggerated concern for personal health.

The appropriate way to deal with the problem is for the MD to decide if this is malingering or psychiatric. If it's psychiatric, a referral to the on-call emerg psychiatrist would be required.

The root cause of the visits would be determined by the psychiatrist, and the diagnosis will dictate the treatment. Cause for the repeat unnecessary medical visits could be an anxiety disorder like GAD, psychosis, or a personality disorder such as histrionic PD.

Originally Posted by Matty1973

Does a doctor have the right to say to a patient you have no physical problems - you have psychological issues?

Not a right... it is an obligation.

Originally Posted by Matty1973

I can imagine that would be very difficult.

It is probably not difficult in the sense that the GP is doing his best to help the patient. Such a patient won't get better with platitudes or placebos.

However, the most common reason psychiatric patients remain untreated in Canada is that the GP may not have the skills to recognize subtler presentment. They'd recognize a full-blown psychotic episode in their office, but probably don't have the experience to conduct a structured interview necessary to identify a mild case of GAD or a PD.



But that's what referrals are for. It's in everybody's best interest if the patient's root problem is correctly identified and he is referred to the correct specialist for best treatment.

[Segnosaur]

I was under the assumption that doctors were somehow bared from prescribing 'placebos' by law.

After all, there are secondary effects for even a harmless 'placebo'...
- The doctor would, in effect, be getting paid for lying to the patient and making false claims. Whatever laws exist probably don't try to make the qualification "Its OK to lie sometimes"
- A person demanding a cure needs mental help, but that is outside the 'expertise' of a family doctor, so he'd be treating a disease he isn't qualified to treat
- If its a homeopathic solution, the person could drown

I have a friend who's sister is a doctor (yeah, I know... not exactly a 'strong' proof...) who claims that that was what she was told.

[blutoski]

Originally Posted by Segnosaur

I was under the assumption that doctors were somehow bared from prescribing 'placebos' by law.

I suppose it's possible that some jurisdiction has this on the books somewhere, but I've never heard of anything that specific in the legal code.

Nevertheless, doctors do have regulatory bodies that almost always say it's unethical and unprofessional conduct to lie to a patient.

The debate revolves around whether telling a patient that a placebo treatment may help them get better is actually a lie if the MD sincerely believes it. This is where the controversy concentrates.

[wolfgirl]

My perception is that the docs aren't prescribing the antibiotics as a placebo exactly, but rather as a way to make the patient think they're doing something for them, like Ethan said. When a person makes an appointment to go to the doc, they expect that the doc is going to be able to help them get better. If the doc just says there's nothing I can do to help you, they feel like they aren't getting the care they deserve and will go to another doc until they get what they think they need. Then in a couple of days when they feel better, which they would have even without the pills, they say that doc helped them get better.

I'm surprised that this still goes on, with everyone seemingly knowing the harm antibiotics are doing to all of us, but I know it does. I'm always hearing someone going to the doc for a sore throat or a cough and they almost always end up with a prescription for antibiotics. Maybe some of them need it, but I'm guessing most of them do not.

[six7s]

Originally Posted by wolfgirl

My perception is that the docs aren't prescribing the antibiotics as a placebo exactly, but rather as a way to make the patient think they're doing something for them.

If this is the case, then surely GPs ought to prescribe 'sugar pills', dispensed from a regular pharmacy

I'm curious to know where this is/is not the case

[BenBurch]

Originally Posted by wolfgirl

My perception is that the docs aren't prescribing the antibiotics as a placebo exactly, but rather as a way to make the patient think they're doing something for them, ...

Which is exactly the original meaning of the term, before anybody had any concept of the imaginary "placebo effect."

[six7s]

Originally Posted by BenBurch

...before anybody had any concept of the imaginary "placebo effect."

Ermmm...

Are you suggesting that its only relatively recently that we have recognised the soothing effects of 'Let mummy kiss it better'?

[athon]

Originally Posted by Matty1973

What do you think is the way to deal with them within the arena of public health care

It's a sad feature of today's world that these people - suffering social isolation for whatever reason - could only find solice by occupying a physician's time and public services in an accident and emergency ward. Occasionally, the more severe 'offenders' were referred to other healthcare workers and found benefits in the care of councilors.

My point is that there is a deficit in healthcare that focuses solely on patient medical needs, when often a lot of older patients and socially isolated members of the community benefit more from personal company and a shoulder to cry on.

Quote:

Does a doctor have the right to say to a patient you have no physical problems - you have psychological issues? I can imagine that would be very difficult.

An A&E physician would not be in a position to make any such diagnosis. They can only make referrals, really, based on their experience. And many do.

Athon

[whatthebutlersaw]

It seems some medical professionals will rationalise prescribing antibiotics for viral infections "to avoid opportunistic bacterial infections". But they do this only when the patient is a pain in the ass insistent.

It seems antibiotics have in some way been used as, what my ex social worker friend described in social work context as "****-off-money": beligerent and difficult clients, eating up the next client's meeting time, could get a couple of bucks "to get a new pair of shoes" just to get them to leave. So antibiotics would have previously been ****-off-medical-treatment. Until it was discovered that this helped bacteria get resistent.

The guidelines have actually been to avoid prescribing antibiotics for a very long time. When I was a child (and that's a loong time ago) I had problem tonsills, with about five bouts of full blown tonsillitis a year for a period of several years and even when it was bacterial, I still got no antibiotics, as they kind of felt that I could just tough it out. Reasoning that since I had so many per year they couldn't really give me antibiotics every time so I might as well never get it. They would rather I was in pain, than prescribe antibiotics. (Yes, I was told that, it is not my guess) As a result of another recommendation at the time, they were also loath to prescribe tonsillectomies. So for a while I was unable to get any help at all for my bally tonsills. Then I grew up, moved town and had to get a new GP who had a quick look at my (at the time uninfected, but since they were chronically inflamed rather enlarged) tonsills and said an unflattering "Eewww" and sent me on to get them out. (My claim to immortality is that my tonsills were so messed up they were preserved, so med students could have a look at them. They are still sloshing around in some jar at the hospital where I got them out) Having them out didn't only get rid of the tonsillitis, I got fewer airway infections in all after that. And immediately gained almost ten pounds - eating is so much better when it doesn't hurt.

Problems like these can be why people insist on getting antibiotics when they do no good. They believe that doctors are holding out on them because of guidelines the patient doesn't understand.

That and the fact that antibiotics have a very dramatic effect when they are prescribed correctly. It's almost like a magic pill - it sure was for me the few times I was given antibiotics. 11AM, horrible pain - 11PM, endurable pain. Next morning: able to eat again. It is difficult to explain to someone why they can't expect that kind of relief every time they get sick.

[korenyx]

I had too many antibiotics in college and I am now allergic to penicillin. The illness I kept having was called "Jock Virus" because it started with the football players. It was coughing, body aches, fever and vomiting. I never did find out what it really was.

[Ove]

It IS a very real problem also because there are cropping up some diseases that cant be cured with penicillin because the bacteria are resistant. The overmedication certainly has a role in that but the agricultural use is also a HUGE problem. The problem is in the piglets, or one of the problems at least. It used to be legal to add penicillin in their diet as "growth accellerator" (i kid you not). That was outlawed so now the huge "pig factories" have found new ways. A piglet needs to be with it's mother for at least 6 weeks to get the usefull stuff from her milk but the farmers take away the piglets after 4 weeks. Then they gets ill and must have penicillin................

My father in law has app. 30% of his lungs left (asbestos) and is more or les constantly on a penicillin cure and his GP is constantly scanning for new types that he havent tried yet. Fortunately there are many types.