Thursday, September 29, 2011

"Test Me for Everything!"

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.

2 comments:

  1. Agree the more the drugs are over used the more they won't work when you really need them. Plus the bugs are getting smarter and developing in resistant strands super bugs. That's why I have to be in extreme pain to take a tylonel.

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