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Disagreements over antibiotics at the doctor's office
Roy Benaroch, MD posted:
One challenge for doctors is to balance patient satisfaction against medical necessity. We want to keep our customers happy so we can stay in business, but at the same time we don't want to order medications and tests that are unlikely to help, and might actually be harmful.

The most common scenario in my office where the doctor's plan and parent's expectations seem to clash is over the issue of antibiotic prescribing. Most parents are aware of the downside of overusing antibiotics, but often parents seem disappointed if they don't get a prescription, even when a child has a viral infection that won't improve with antibiotics.

Have you been disappointed when the doctor doesn't prescribe what you expected? What can doctors and families do to "bridge the gap" in communication? Are there ways in which your doctors could handle this better?
FCL responded:
I have never expected a prescription for antibiotics. I chose my doctor(s) with care and have every faith in what s/he prescribes. There is no way on earth I'd demand a treatment that s/he felt was unnecessary. (I'd ask for an explanation but there is always an explanation forthcoming :) ). Maybe I'm lucky enough to have doctors who communicate well and explain they whys and wherefores ... maybe it's because I ask why if I don't understand.

As in many situations, communication and trust are of prime importance.
phoenix31674 responded:
I've never expected antibiotics and would actually prefer not having them unless it's known to be something bacterial. Of course, the only times LO has been sick, I pretty much new it was a virus and didn't even take her in since there's nothing you can really do for a virus if you have only a mid-grade fever and are still eating and drinking.

I don't know if it's because doctors are so overscheduled that they don't have time to educate parents on why antibiotics should not be perscribed. I know that many parents grew up in a time when drugs were the panacea for everything and a visit to the doctor will ill meant you would get a drug and you feel gypped if you don't get something, so that may play into it.
Lainey_WebMD_Staff responded:
Our doctor was selected by me and DH because of his views regarding medication. I have sent my entire family to him. We feel some doctors rely on medication far too much. Both my son's were told by their schools that they should be considered for Ritalin, which angered me. My doctor sent a letter to the school stating he has taken care of my boys for years and they don't need Ritalin but the school needs to change the lunch choices because of the dye and sugars (which my boys were not accustomed) caused my boys to act out. Our doctor has cared for two generations of my family. We have even switched insurance when our doctor decided to no longer accept it. I get a monthly email with health topics that our doctor wants us aware of.
Louise_WebMD_Staff responded:
I am pretty much anti-antibiotic without proof, just because I end up with complications from taking them. I also have a sibling who is antibiotic resistant after years of taking them willy-nilly.

I think posters and handouts for parents explaining ways to help a child feel better without antibiotics go a long way. Parents don't necessarily want a magic pill for making their child feel better, I think we just suffer when our kids feel sick.

I think a doctor endorsing alternative ideas can help a lot.

I have noticed with my mother (I am her caregiver and she lives with me) that if the doctor agrees with my non-medicated methods of helping her various conditions. (healthier diet, more fiber, more exercise, etc.) she is far more responsive to them. Even with things like colds and viruses, it makes a big difference. Last year, she insisted she needed an antibiotic because she is diabetic and has all these health problems. She had a cold. We all had the cold. An antibiotic wouldn't fix the issue. She made an appointment with the doctor. We went in. I explained during the recitation of symptoms that yes, we all had this virus and here is what I thought would work. (handwashing, Tylenol, plenty of liquids, tincture of time, rest, vapo-rub, etc) The doctor agreed and suggested an OTC cough syrup appropriate for her. She asked about antibiotics (since "it always turns into bronchitis") and she had "green slime" and the doctor explained to her what I had already told her--the antibiotic wouldn't help and could hurt when she really needed it. (as well as increase the chance of yeast infections since she was prone to them when she first moved here and her sugar was out of control) She grumbled, but since then she has not wanted to go in to see the doctor for the same set of symptoms.

No, she isn't a child, but she is an example of an adult who does want the magic pill but needs to understand and be reminded that they only work on a certain type of illness--not all of them.

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