Change in procedures at Dr.s officegreenspun.com : LUSENET : TimeBomb 2000 (Y2000) : One Thread
Last Friday my 4 year old daughter was running a temperature. When it reached 102 we took her into the emergancy room. The doctor examined her then explained to us that she has a viral infection and antibiotics are only effective for bacterial infections. Said to give her Motrin .
Now I already knew this but I am 56 years old and no doctor had ever said it before. They have always given a shot just in case.
Then on Tuesday I had caught her flue and I went to my personal Dr. He said the same thing. 6 months ago with the same symptoms he gave me an antibiodic.
What they are doing is correct BUT they have never done it before. Why now????? Are meds being stock piled?
-- Mr. Pinochle (firstname.lastname@example.org), November 24, 1999
More likely are concerned about the threat of antibiotic resistant bacteria.
-- mushroom (email@example.com), November 25, 1999.
Doctors, in the past, prescribed antibiotics because their patients wanted them--not necessarily because they needed them. Current research has proven that over-prescription of antibiotics is a contributing factor to antibiotic resistance in bacteria (there are many other factors involved as well).
Doctors have finally decided that the customer is not always right and are no longer prescribing antibiotics on demand. Has nothing to do with stockpiling.
-- Sam Mcgee (firstname.lastname@example.org), November 25, 1999.
I agree with both of you. But why did two different doctors in two different locations both decide to do ths at the same time and give almost verbatum the same reason. it was aaas if they were readind the explanation to me. remember I,ve had the one Dr. for years.
-- Mr. Pinochle (email@example.com), November 25, 1999.
If you're on an HMO the other explaination might be that Docs are stiffening about overprescribing because, if capitated, the costs come out of their pockets.
-- Carlos (firstname.lastname@example.org), November 25, 1999.
Carlos-- You are right--I totally forgot about that one. HMO's and PPO's are getting very miserly about prescription drugs.
-- Sam Mcgee (email@example.com), November 25, 1999.
I am a pediatrician. I finished my training in 1986 and since then have been in private practice. We were warned back then of the overuse of antibiotics and the development of resistent strains of bacteria. We were also warned of "demanding parents" and taught the lines you only heard recently. We were told that we may lose patients due to practicing "disciplined" medicine, but it was important to train the public in the right way and not cave in.
Well, I remember thinking that a "green nasal discharge" must be bacterial so I would treat that. Now we are taught that the natural course of a viral cold progresses with nasal drainage from clear to yellow to green and back to clear again over about a two week period and not to treat as a sinusitis or bacterial rhinitis unless facial pain due to sinus pressure are present.
I also remember thinking that a "red eardrum" needs to be treated with an antibiotic. Now we are being informed that the majority of red ears are due to viral infections. In the UK the most recommended medication for earaches and red ears is Tylenol (acetaminaphen). Most ear infections resolve whether treated or not. Chronic eustation tube dysfunction caused by allergies, wood heat, cigarette smoke, (new analysis suggests that sucking on a bottle lying down does not contribute to the problem but I have gotten comfortable in saying it is okay)daycare exposure, as well as other factors have been implicated in chronic or recurrent otitis media.
The new push now is that for pus filled ear drums (that are almost certainly bacterial) should be punctured in the office and the contents cultured. "If you have an abscess,it must be drained." For now I will be content to send those patients to the ENT.
Yes, the trend is to stop the inappropriate use of antibiotics. I do not think it is HMO or PPO pressure as I have not sensed any. The pressure is to practice good, sound medicine and do what is best for our patients. By the way, we still treat pneumonia with antibiotics as we are unable to tell with certainty if is viral or bacterial. Strep throat, urinary tract infections, and bacterial skin infections still require antibiotics. We still use antibiotics before dental procedures in patients with heart valve problems to prevent bacterial endocarditis.
This has been long but hopefully insightful.
Joe W. Wiley, MD Centralia, WA
-- Joe W. Wiley, MD (firstname.lastname@example.org), November 25, 1999.
My doctor has practiced this way since my daughter was born. His theory was "Momma, her little body's got to learn to fight these things." But, he would also give me a laundry list of things to watch for and actions to take if symptoms got worse, including the one's which should send me back to his office. I'll bet she wasn't on an antibiotic more than three times in her life. As a result, I have a child who is almost never sick. She had strep last year, and it stunned me, because it is so unusual to see her sick. I love our doctor. Full of common sense, compassion, and integrity. I wouldn't trade him for anything.
-- margie mason (email@example.com), November 25, 1999.
I had the same thing happen to me two months ago. Dizziness, very tired, and two weeks of diarrhea. My doctor told me it was a viral bug, and to change my diet (stay away from milk products). If the symptoms hadn't changed in a week, I was supposed to have returned.
I don't think it's stockpiling though, I agree it's about stopping bacteria from becoming drug-resistant. I've been able to get Amoxicillin just two weeks ago, when I had a wisdom tooth cut out.
-- Deb M. (firstname.lastname@example.org), November 25, 1999.
Thank you for posting, Dr. Wiley.
There are several Drs on the Forum, and it is very helpful when they post!
-- Ashton & Leska in Cascadia (email@example.com), November 25, 1999.
Hey Joe...the next time you run into Larry Nelson, tell him Judith Richardson said hello.
-- Taz (Tassie123@aol.com), November 25, 1999.