A patient walks into my office
expecting a prescription for an antibiotic,
but I don’t write one.
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.
Let’s set the scene here.
We have a 38 year old female
that comes in with a chief complaint of upper respiratory symptoms.
It’s been going on for a period of two to three days,
and her main complaints come from fatigue,
sore throat, dry cough, and runny nose.
A little bit of background on the patient–
she has two children, is currently married,
and has a very stressful job.
Probably the most important part of the story is that
she has a vacation coming up in 11 days,
and she’s worried that this infection may interfere with those plans.
Normal vital signs,
pertinent positives: inflamed nostrils, inflamed throat,
pertinent negatives: no exudates on the tonsils,
which means those nasty little white plaques that you sometimes see.
Clear lungs, no abdominal pain, no rashes,
and very importantly no swollen lymph nodes.
At this point I had a very strong suspicion that
my patient has a viral illness.
I don’t even know which viral illness,
but it doesn’t make much of a difference
because it doesn’t change my management,
viruses are treated in the same manner.
We give supportive care to the patient,
treat their symptoms,
make sure they get enough rest, hydration,
in order for their own bodies to fight off those infections.
When I told the patient about my diagnosis,
she met it with hesitation,
and wanted to know if she was gonna get a prescription for antibiotics.
I explained to her that antibiotics don’t work on viral conditions
like the one that I suspect that she was having.
I had to explain to her that
weighing the risks versus benefits here,
I still thought that not using antibiotics was the right move.
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.
Come Sunday, two days later,
the patient calls my office,
and lets me know that she’s not getting better,
and she’s wondering if she should go to an urgent care facility.
I talked to her about her symptoms.
It just, to me, seems like her viral illness still hasn’t improved
because she hasn’t reached that day six, day seven, where we usually see a turnaround.
And I told her that it was in her best interest
to stick with the symptom management,
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.
Lets me know that she’s feeling a lot better and turned around on day six.
All her symptoms pretty much resolved.
She did let me know that
on Sunday she ended up going to an urgent care facility,
and got a rapid strep test done
which came up negative as we initially thought.
So she was very grateful that we didn’t unnecessarily treat her with antibiotics.
And it was a good result.
And I thought it was important to talk about this result
because it’s a very common situation
where doctors either over-prescribe antibiotics
or doctors don’t prescribe an antibiotic,
and then patients get really upset about it.
So let’s talk about that.
The situation of a patient coming in and requesting antibiotics
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.
Reason number one, resistance.
Antibiotics work against certain bacteria that are not resistant to them.
However, when you give patients antibiotics over and over again,
you create a type of bacteria known as a super bug
which actually becomes resistant to that antibiotic,
and therefore an antibiotic becomes useless.
And there’s only so many antibiotics out there
where we can actually run out of antibiotics to give a patient
because they have such a multi drug resistant bacterial infection.
Second, adverse reactions.
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
where you kill all the good bacteria in your bowels.
So that this bad bacteria grows and festers and you have the worst bacteria ever.
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”.
You would have felt better without the antibiotic.
In fact, when we treat a strep throat with antibiotics,
we’re not even really treating the strep throat.
It would get better on its own.
The reason we give antibiotics here is
to prevent the complications of strep throat
like rheumatic fever, kidney issues.
Let that sink in for a moment.
最后一点 原因四 费用
And finally, four, the cost.
Why would you spend money on antibiotics when you have a virus?
They’re not even gonna be helping you and possibly harming you.
The art of medicine is about balancing the risks versus benefits, to be in your favor.
Now let’s move on and talk about what pressures doctors face to prescribe antibiotics,
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,
a patient comes in and requests, firmly, an antibiotic.
You can discuss very clearly with them
why you think an antibiotic isn’t the optimal choice.
You can explain the risks, the benefits,
and the patient can still request the antibiotic.
So you go ahead and write one.
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,
where if a patient doesn’t get the treatment they expected to get,
they can leave a nasty review that can truly hurt your own business.
Think about it: if I open my own practice,
and I’m trying to establish myself,
and have a good name and give quality service,
and not give unnecessary antibiotics,
but a patient really wanted them,
they leave me a bad review,
that can really hurt my business.
Three is something you may not have heard of it.
It’s “CYA medicine”,
cover your butt medicine.
Essentially what doctors are doing is
that they’re afraid that
if you don’t prescribe antibiotics for a patient,
and they actually do have a bacterial infection,
they get worse, they may be held liable through a lawsuit,
and that’s scary stuff for a doctor.
You don’t want to be sued by a patient
especially in the age we live in
where it seems everybody’s just suing everybody all the time.
Fourth is patient satisfaction.
If a patient pays to go to the doctor’s visit,
and leaves with no prescription,
and instead leaves with advice to drink green tea, honey and hydrate,
they feel like they didn’t get a lot out of the visit and can leave very unhappy.
But we have to remember,
the reason we pay for a doctor’s visit is not to buy a prescription,
it’s to consult a doctor on their medical opinion
as to what’s going on with you,
and what is the best treatment option to solve that problem.
Please don’t think I’m anti-antibiotics.
Antibiotics are a life-saving drug,
and, when appropriate, is so important to give.
In fact, if someone has a viral infection,
they become more susceptible to getting a bacterial infection on top of it,
so that if you initially have symptoms of a viral illness
that suddenly get worse,
you may need antibiotics.
I’m definitely for antibiotics.
But I’m for responsible use of antibiotics.
We covered antibiotics and I told you my story.
But I also happen to go to my PO Box today,
and picked up some packages.
Oh my God, why is everyone sending these shirts?
It’s a Newfoundland, with a little heartbeat.
Bear, what do you think about this shirt?
What do you think?
California, San Diego.
Oh, my gosh.
Chest compressions, Chest Compressions.
Cynthia, thank you so much for this shirt.
“If you don’t start making merch soon, I swear to God…”
I’m sorry, I’m working with the trademark attorney.
There’s so much nonsense when it comes to making your own merch.
I’m a doctor.
I have no idea what I’m doing.
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 Easter eggs.
White chocolate KitKats.
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.
Look at these candies.
This is misleading the obesity epidemic,
but I’m gonna love it, thank you so much.
”Safeguard your family’s health with a mild laxative.”
“Healthway products from 1950…” Whoa.
Is this like, this looks genuine, this is like an artifact.
Carol, this is amazing.
I’m gonna say this, I don’t want to show you guys what this is.
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”.
Because everybody needs a carb,
Bear, bomb check? Good.
“First aid kit, do not open unless emergency.”
That’s so sweet.
You guys need to watch my video that I did with my nephew Arie
where we did a disgusting science experiment.
So click here for that bad boy and as always stay happy and healthy.