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我为什么不给这个患者开抗生素

She Asked For Antibiotics & I said NO | Wednesday Checkup

一位病人走进我的办公室
A patient walks into my office
想让我开一张抗生素的处方
expecting a prescription for an antibiotic,
但我没有开
but I don’t write one.
本周《周三体检》就来聊聊发生了什么
Let’s talk about what happens on this week’s Wednesday Checkup.
麦克医生 《周三体检》 第27集
Doctor Mike, Wednesday Checkup, Episode 27.
假设有这样的情境
Let’s set the scene here.
一位38岁的女性
We have a 38 year old female
主诉上呼吸道症状
that comes in with a chief complaint of upper respiratory symptoms.
症状已持续两到三天的时间
It’s been going on for a period of two to three days,
然后她的主要症状是疲乏
and her main complaints come from fatigue,
喉咙痛 干咳和流鼻涕
sore throat, dry cough, and runny nose.
还有关于她的一些基本状况
A little bit of background on the patient–
患者现已婚 育有两个孩子
she has two children, is currently married,
工作压力山大
and has a very stressful job.
最重要的是
Probably the most important part of the story is that
她11天后要去度假
she has a vacation coming up in 11 days,
所以担心这次感染会妨碍她的计划
and she’s worried that this infection may interfere with those plans.
生命体征正常
Normal vital signs,
没有发烧
no fever,
相关的阳性体征:鼻孔发炎 咽喉红肿
pertinent positives: inflamed nostrils, inflamed throat,
相关的阴性体征:扁桃体无渗出液
pertinent negatives: no exudates on the tonsils,
也就是上面那些恶心的小白斑
which means those nasty little white plaques that you sometimes see.
肺音清晰 无腹痛和皮疹
Clear lungs, no abdominal pain, no rashes,
还有很重要的一点是淋巴结没有肿大
and very importantly no swollen lymph nodes.
这时候我强烈地怀疑
At this point I had a very strong suspicion that
我的病人患有病毒性疾病
my patient has a viral illness.
我还不知道是哪种病毒性疾病
I don’t even know which viral illness,
但这影响不是很大
but it doesn’t make much of a difference
因为这不会改变我的治疗
because it doesn’t change my management,
病毒都是用同一种方法治疗的
viruses are treated in the same manner.
我们给病人提供支持性护理
We give supportive care to the patient,
治疗症状
treat their symptoms,
确保他们得到足够的休息和水分
make sure they get enough rest, hydration,
这样 他们自己的身体才能抵抗感染
in order for their own bodies to fight off those infections.
当我把诊断结果告知这位病人时
When I told the patient about my diagnosis,
她有些犹豫
she met it with hesitation,
并且想知道能不能得到抗生素的处方
and wanted to know if she was gonna get a prescription for antibiotics.
我向她解释 抗生素对病毒没用
I explained to her that antibiotics don’t work on viral conditions
就比如我怀疑她感染到的那个病毒
like the one that I suspect that she was having.
我不得不跟她解释
I had to explain to her that
在衡量利弊之后
weighing the risks versus benefits here,
我仍认为不使用抗生素是正确的
I still thought that not using antibiotics was the right move.
她相信了我
She put her trust in me
并告诉我 如果出现任何问题 她会在周末打电话给我
and told me that she would call me over the weekend if any problems were to arise.
两天后的周日
Come Sunday, two days later,
这位病人打电话到了我的办公室
the patient calls my office,
并告诉我她没有好转
and lets me know that she’s not getting better,
她想知道她是否应该去一个紧急护理中心
and she’s wondering if she should go to an urgent care facility.
我问起了她的症状
I talked to her about her symptoms.
在我看来 她只是病毒性疾病还没好转而已
It just, to me, seems like her viral illness still hasn’t improved
因为症状通常要等到第6到7天才会好转
because she hasn’t reached that day six, day seven, where we usually see a turnaround.
然后我告诉她 她最好
And I told her that it was in her best interest
坚持症状的治疗方法
to stick with the symptom management,
多休息 多喝水
treat herself with rest, hydration,
多喝绿茶和蜂蜜 然后继续治疗 两天后给我电话
with green tea and honey, and stick through it, and give me a call in two days.
想不到 想不到 病人两天后打电话给我
Surprise, surprise, patient calls me in two days.
告诉我她在第六天的时候感觉好多了
Lets me know that she’s feeling a lot better and turned around on day six.
所有症状几乎都消失了
All her symptoms pretty much resolved.
她还告诉我
She did let me know that
她周日去了紧急护理中心
on Sunday she ended up going to an urgent care facility,
做了一次链球菌快速检测
and got a rapid strep test done
结果不出所料是阴性的
which came up negative as we initially thought.
所以她很感激我们没有用不必要的抗生素来进行治疗
So she was very grateful that we didn’t unnecessarily treat her with antibiotics.
这是个好结果
And it was a good result.
而我觉得讨论这个结果很重要
And I thought it was important to talk about this result
因为这种情况很常见
because it’s a very common situation
医生要么开了过量的抗生素
where doctors either over-prescribe antibiotics
要么不开抗生素
or doctors don’t prescribe an antibiotic,
让病人为此感到不高兴
and then patients get really upset about it.
所以我们来聊聊这个
So let’s talk about that.
很多病人会在不需要吃抗生素的情况下
The situation of a patient coming in and requesting antibiotics
要求医生开抗生素
when they’re not actually needed or indicated happens quite often.
首先 我要告诉你 为什么医生不应该开不必要的抗生素
And I want to start off by telling you why doctors should not be prescribing antibiotics unnecessarily.
原因一 抗药性
Reason number one, resistance.
抗生素能对付那些对其没有抗药性的细菌
Antibiotics work against certain bacteria that are not resistant to them.
不过 当你一次次地给病人开抗生素
However, when you give patients antibiotics over and over again,
你就会创造一种叫做“超级病菌”的细菌
you create a type of bacteria known as a super bug
它对那种抗生素产生了抗药性
which actually becomes resistant to that antibiotic,
从而让这种抗生素变得无效
and therefore an antibiotic becomes useless.
而世界上只有这么多抗生素
And there’s only so many antibiotics out there
要是病人被这样的耐药细菌感染
where we can actually run out of antibiotics to give a patient
我们可能再也没有能开给病人的抗生素了
because they have such a multi drug resistant bacterial infection.
原因二 不良反应
Second, adverse reactions.
我是说过敏反应 如喉咙堵塞
I’m talking about allergic reactions where the throat closes up,
发疹 腹泻 以及一种叫做艰难梭菌的感染
rashes, diarrhea, and infection known as Clostridium difficile
就是你杀死了肠道里所有的有益菌
where you kill all the good bacteria in your bowels.
以至于使有害细菌生长恶化 更加有害
So that this bad bacteria grows and festers and you have the worst bacteria ever.
原因三 抗生素对病毒没用
Three, antibiotics don’t work against viruses.
我知道很多人说 “嗯 我一用了抗生素就感觉到好转”
I know many people say “well, as soon as I got the antibiotic I felt better”.
本来你没用抗生素也会感到好转的
You would have felt better without the antibiotic.
事实上 当我们用抗生素治疗链球菌性喉炎时
In fact, when we treat a strep throat with antibiotics,
我们不是在治疗它
we’re not even really treating the strep throat.
它自己就能好起来
It would get better on its own.
我们在这里提供抗生素的原因是
The reason we give antibiotics here is
为了预防它的并发症
to prevent the complications of strep throat
如风湿热 肾脏问题
like rheumatic fever, kidney issues.
好好理解一下
Let that sink in for a moment.
最后一点 原因四 费用
And finally, four, the cost.
当你感染了病毒 为什么你要花钱在抗生素上
Why would you spend money on antibiotics when you have a virus?
它们帮不了你 甚至可能有害于你
They’re not even gonna be helping you and possibly harming you.
医学的艺术就是权衡利弊来帮助你
The art of medicine is about balancing the risks versus benefits, to be in your favor.
现在我们继续来讨论 医生在开抗生素所面临的压力
Now let’s move on and talk about what pressures doctors face to prescribe antibiotics,
尽管这可能不是治疗的恰当选择
even though they may not be the appropriate choice of treatment.
第一 病人的要求 就像我的故事里那样
First, patient requests. Like we had in my story,
一位病人走进来 坚决地要求抗生素
a patient comes in and requests, firmly, an antibiotic.
你可以和他们清晰地详述
You can discuss very clearly with them
你认为抗生素不是最佳选择的原因
why you think an antibiotic isn’t the optimal choice.
你可以解释它的风险和好处
You can explain the risks, the benefits,
但病人坚持要求抗生素
and the patient can still request the antibiotic.
于是你就开了抗生素
So you go ahead and write one.
第二个与第一个的联系很紧密
The second connects very closely with the first
在这些医生评论网站上 像Zocdoc Yelp等等
and it’s these doctor review sites like Zocdoc, Yelp and so forth,
如果病人得不到他们所希望的治疗
where if a patient doesn’t get the treatment they expected to get,
他们会留下负面的评价 这会有损你的生意
they can leave a nasty review that can truly hurt your own business.
想一想:如果我开了自己的诊所
Think about it: if I open my own practice,
我努力想要站稳脚跟
and I’m trying to establish myself,
建立好的信誉 提供优质服务
and have a good name and give quality service,
却不提供不必要的抗生素
and not give unnecessary antibiotics,
但病人确实想要它
but a patient really wanted them,
他们留下差评
they leave me a bad review,
损害到了我的业务
that can really hurt my business.
第三个是你可能没听过的
Three is something you may not have heard of it.
“CYA 医疗”
It’s “CYA medicine”,
也就是防御性医疗
cover your butt medicine.
本质上医生在做的事情是
Essentially what doctors are doing is
他们害怕
that they’re afraid that
如果自己不开抗生素给病人
if you don’t prescribe antibiotics for a patient,
而病人确实受到了细菌感染
and they actually do have a bacterial infection,
然后病情加重 他们可能挨告
they get worse, they may be held liable through a lawsuit,
那对医生来说是件可怕的事情
and that’s scary stuff for a doctor.
你不想被病人起诉
You don’t want to be sued by a patient
特别是在我们这个时代
especially in the age we live in
似乎每个人都在一直起诉别人
where it seems everybody’s just suing everybody all the time.
第四个是病人的满意度
Fourth is patient satisfaction.
如果一位病人花钱去看医生
If a patient pays to go to the doctor’s visit,
离开时却拿不到药方
and leaves with no prescription,
而只是得到了喝绿茶 蜂蜜和水的建议
and instead leaves with advice to drink green tea, honey and hydrate,
他们会觉得这次门诊没让自己获益 于是很不开心地离开
they feel like they didn’t get a lot out of the visit and can leave very unhappy.
但是我们要记住
But we have to remember,
我们花钱去看医生不是为了买一张药方
the reason we pay for a doctor’s visit is not to buy a prescription,
而是向医生咨询 关于你的身体状况
it’s to consult a doctor on their medical opinion
他们的医疗意见
as to what’s going on with you,
以及治疗疾病的最佳选择
and what is the best treatment option to solve that problem.
请不要以为我是反抗生素者
Please don’t think I’m anti-antibiotics.
抗生素是一种救命药
Antibiotics are a life-saving drug,
在特殊的时候 抗生素是非常重要的
and, when appropriate, is so important to give.
事实上 如果一个人患上了病毒性感染
In fact, if someone has a viral infection,
他们可能更容易同时受到细菌感染
they become more susceptible to getting a bacterial infection on top of it,
所以如果你一开始有病毒性疾病的症状
so that if you initially have symptoms of a viral illness
但症状突然恶化
that suddenly get worse,
你可能需要抗生素
you may need antibiotics.
我绝对支持抗生素
I’m definitely for antibiotics.
但我支持的是抗生素的负责任的使用
But I’m for responsible use of antibiotics.
我们讨论了抗生素 我给你讲了我的故事
We covered antibiotics and I told you my story.
但我今天也打开了我的邮政信箱
But I also happen to go to my PO Box today,
取到了一些包裹
and picked up some packages.
宾夕法尼亚
Pennsylvania.
天哪 为啥每个人都送这些衬衫
Oh my God, why is everyone sending these shirts?
这是一条纽芬兰犬 带有心跳
It’s a Newfoundland, with a little heartbeat.
Bear 你觉得这件衬衫怎么样
Bear, what do you think about this shirt?
你认为呢
What do you think?
加利福尼亚 圣地亚哥
California, San Diego.
天哪
Oh, my gosh.
胸外按压 胸外按压
Chest compressions, Chest Compressions.
Cynthia 非常感谢你的这件衬衫
Cynthia, thank you so much for this shirt.
“如果你还不出周边 我向上帝发誓……”
“If you don’t start making merch soon, I swear to God…”
我很抱歉 我正在与商标律师协商
I’m sorry, I’m working with the trademark attorney.
出自己的周边是一件很麻烦的事情
There’s so much nonsense when it comes to making your own merch.
我是一位医生
I’m a doctor.
我不知道我要做什么
I have no idea what I’m doing.
但我保证不久后就会有周边
But I promise there’s gonna be merch soon.
日本 哇 日本的KitKat巧克力
Japan. Oh, little Japanese KitKat action.
KitKat复活节彩蛋
KitKat Easter eggs.
KitKat白巧克力
White chocolate KitKats.
谢谢你 我的日本朋友
Thank you my Japanese friend.
这个来自丹麦 看看这个 看这些糖
This is from Denmark, look at this, look at these candies.
看看这些糖
Look at these candies.
尽管这些糖只会误导那些肥胖症的人
This is misleading the obesity epidemic,
但我很喜欢 非常感谢
but I’m gonna love it, thank you so much.
“用一种温和的泻药来保护你的家人的健康”
”Safeguard your family’s health with a mild laxative.”
“1950年的健康之路的产品” 哇
“Healthway products from 1950…” Whoa.
这看上去像是真的 这像一个文物
Is this like, this looks genuine, this is like an artifact.
Carol 这太棒了
Carol, this is amazing.
我得说 我不想给你们看到这是什么
I’m gonna say this, I don’t want to show you guys what this is.
里头讲述的是50年代的奇怪的保健品
This is weird health products from the 50s.
这个来自牙买加 哦 《灵命日粮》
This one’s from Jamaica. Oh, “Our Daily Bread”.
因为每个人都需要糖类
Because everybody needs a carb,
Bear 看看有没有炸弹?很好
Bear, bomb check? Good.
“急救药箱 只有紧急情况才能打开”
“First aid kit, do not open unless emergency.”
这太贴心了
That’s so sweet.
你们得看看我和我侄子Arie一起拍下的视频
You guys need to watch my video that I did with my nephew Arie
我们做了一个很恶心的科学实验
where we did a disgusting science experiment.
所以为那个坏小子点击这里 一直保持开心和健康
So click here for that bad boy and as always stay happy and healthy.

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视频概述

医生为什么不给患者开抗生素

听录译者

ABC

翻译译者

春风十里不如你

审核员

审核员B

视频来源

https://www.youtube.com/watch?v=whcLEyG81SQ

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