Doctors told to stop prescribing antibiotics for coughs and colds

[Matty1973]

"Experts at the influential centre, based in Stockholm which is focused on controlling infectious diseases in Europe, say the prescription of the pills, which are not necessary in most cases, is fuelling the rise in the number of infections that are resistant to antibiotics."

http://www.telegraph.co.uk/health/h...cribing-antibiotics-for-coughs-and-colds.html

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

 

[Dymanic]

I think that is a very clever idea.

 

[six7s]

...so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Maybe...

But the doctors would first have to take the hypocritic oath:

do no good​

 

[athon]

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

In either case, it's avoiding the central issue. There is more to medicine than simply offering a pill.

The real reason alternative medicineis so popular is that it does two things - makes the patient feel in control of their own health, and connects them with other people who seem to be genuinely concerned for them as a person. The (non)science behind it is often more accessible to the lay person, provides (false) hope and arises from social thinking rather than the more harsh critical thinking of science. Importantly, practitioners often give more time to discussing the patient's anxieties and engaging with their emotional needs.

If a GP were to administer a homeopathic pill, I don't see it addressing the ultimate need of a patient. I know when I worked in an Accident and Emergency department of a hospital we'd often see the same patients come in who could be described as hypchondriacs.

Flipping another pill is simply not the way to deal with them.

Athon

 

[six7s]

The (non)science behind it is often more accessible to the lay person, provides (false) hope and arises from social thinking rather than the more harsh critical thinking of science.

Also... woo-ey family and friends are likely to be more sympathetic towards a patient who - in consulting a quack - is 'at least doing something'

 

[shandyjan]

It always surprises me, as never in my life, or with my children have any of us been given antibiotics for coughs and colds.

 

[The Fallen Serpent]

Some people are very insistent that they be given a cure once they have a doctor's attention.

 

[Jeff Corey]

It always surprises me, as never in my life, or with my children have any of us been given antibiotics for coughs and colds.

Me neither. After dental surgery as prophylaxis, might have been unnecessary.

 

[Careyp74]

You shouldn't give homeopathic medicine for coughs and colds, you will increase the resistance to the placebo effect, too! Just feed a cold, or starve it, whatever.

 

[Miss_Kitt]

I am amazed when I hear about this, but I have had doctors I know in this skeptic community say that they were taught to dispense antibiotics if the patient 'really wanted something'. I regard that as highly irresponsible. The doctor may need to take the time to educate the patient a bit as to why their condition does not require prescription meds; and/or write a note suggesting OTC meds that may provide relief, so that the patient feels like they have "doctor's orders."

I would love to hear from medical practitioner here on the subject of whether they think it is ethical to give what you know is a useless antibiotic to a patient, just to avoid having to tell them 'No'.

 

[athon]

I would love to hear from medical practitioner here on the subject of whether they think it is ethical to give what you know is a useless antibiotic to a patient, just to avoid having to tell them 'No'.

To be fair, a lot of GPs don't give antibiotics for viruses simply as placebos, but rather to address actual or potential secondary infections.

Yet my opposition to this remains, given it's only in high risk groups do secondary infections really ever turn into anything nasty. In other words, even a bit of a resulting chest infection will typically fade within a week or so - only a little longer than if the patient had have attacked it with antibiotics.

Athon

 

[Matty1973]

I know when I worked in an Accident and Emergency department of a hospital we'd often see the same patients come in who could be described as hypchondriacs.

Flipping another pill is simply not the way to deal with them.

Athon

What do you think is the way to deal with them within the arena of public health care and do you think they currently receive that service?

Does a doctor have the right to say to a patient you have no physical problems - you have psychological issues? I can imagine that would be very difficult.

 

[fagin]

I once phoned my doctor with a really bad case of flu asking if anything would help. He suggested a shotgun was the only definite cure.

 

[Ethan Thane Athen]

My friend is a GP and this drives her mad. She tells patients they have a viral infection and that antibiotics won't help but they re-book to see one of her colleagues and they happily prescribe antibiotics. When she's tackled them on this they just shrug and say 'Well it keeps them happy and off my back.'.

What makes it even more annoying for her is that the patients then feedback to eachother and the practice that she's a rubbish doctor who 'Couldn't do anything' but 'Good old Doctor X sorted me out'.

She's actually wavered on occasion and considered joining in to avoid losing even more patients but has so far resisted...

 

[lomiller]

I suspect the use of those same antibiotics in agriculture is an even bigger problem. Otherwise, I tend to agree. Physicians should not be giving antibiotics speculatively, they should be targeting a specific condition and using the correct amount to resolve that condition.

I can see it from a doctors perspective though. Proscribing antibiotics is unlikely to harm their patient and may end up helping them while the damage done is externalized and not their responsibility.

 

[blutoski]

"Experts at the influential centre, based in Stockholm which is focused on controlling infectious diseases in Europe, say the prescription of the pills, which are not necessary in most cases, is fuelling the rise in the number of infections that are resistant to antibiotics."

http://www.telegraph.co.uk/health/h...cribing-antibiotics-for-coughs-and-colds.html

So I was thinking - how about prescribing homoeopathic remedies to patients who insist on getting a prescription instead of the antibiotics. The article says antibiotics do not combat viruses so morally it can't be any worse to prescribe an alternative ineffective treatment like homoeopathy and this way there will be no side effects and no build up of resistance.

My worry would be that it then it gives respectability to the homoeopathic industry so why not go one step further and make homoeopathic remedies only available from a doctor. That way all patients would get to see a medical doctor so no one would be left getting ineffective treatment for a serious problem and it would also give doctors a way of 'treating' hypochondriacs and those who insist on antibiotics in the wrong situations.

Does the end justify the means?

I think there's a misunderstanding, though. Prescribing antibiotics for cold and flu remains appropriate for some patients, and the purpose is to reduce the risk of complications.

When you hear about deaths from flu the most common cause is pneumonia, which can be prevented with antibiotics.

My impression is that the overprescribing of antibiotics for cold and flu is MDs being overly cautious about opportunistic bacterial infections - not an attempt to administer a placebo.

 

[blutoski]

What do you think is the way to deal with them within the arena of public health care and do you think they currently receive that service?

Hypochondria is not a diagnosis in and of itself.

Whether it's their first suspicious visit, or a return visit that shows a pattern, the emerg MD will have determined at some point that the patient has an exaggerated concern for personal health.

The appropriate way to deal with the problem is for the MD to decide if this is malingering or psychiatric. If it's psychiatric, a referral to the on-call emerg psychiatrist would be required.

The root cause of the visits would be determined by the psychiatrist, and the diagnosis will dictate the treatment. Cause for the repeat unnecessary medical visits could be an anxiety disorder like GAD, psychosis, or a personality disorder such as histrionic PD.

Does a doctor have the right to say to a patient you have no physical problems - you have psychological issues?

Not a right... it is an obligation.

I can imagine that would be very difficult.

It is probably not difficult in the sense that the GP is doing his best to help the patient. Such a patient won't get better with platitudes or placebos.

However, the most common reason psychiatric patients remain untreated in Canada is that the GP may not have the skills to recognize subtler presentment. They'd recognize a full-blown psychotic episode in their office, but probably don't have the experience to conduct a structured interview necessary to identify a mild case of GAD or a PD.



But that's what referrals are for. It's in everybody's best interest if the patient's root problem is correctly identified and he is referred to the correct specialist for best treatment.

 

[Segnosaur]

I was under the assumption that doctors were somehow bared from prescribing 'placebos' by law.

After all, there are secondary effects for even a harmless 'placebo'...
- The doctor would, in effect, be getting paid for lying to the patient and making false claims. Whatever laws exist probably don't try to make the qualification "Its OK to lie sometimes"
- A person demanding a cure needs mental help, but that is outside the 'expertise' of a family doctor, so he'd be treating a disease he isn't qualified to treat
- If its a homeopathic solution, the person could drown

I have a friend who's sister is a doctor (yeah, I know... not exactly a 'strong' proof...) who claims that that was what she was told.

 

[blutoski]

I was under the assumption that doctors were somehow bared from prescribing 'placebos' by law.

I suppose it's possible that some jurisdiction has this on the books somewhere, but I've never heard of anything that specific in the legal code.

Nevertheless, doctors do have regulatory bodies that almost always say it's unethical and unprofessional conduct to lie to a patient.

The debate revolves around whether telling a patient that a placebo treatment may help them get better is actually a lie if the MD sincerely believes it. This is where the controversy concentrates.

 

[wolfgirl]

My perception is that the docs aren't prescribing the antibiotics as a placebo exactly, but rather as a way to make the patient think they're doing something for them, like Ethan said. When a person makes an appointment to go to the doc, they expect that the doc is going to be able to help them get better. If the doc just says there's nothing I can do to help you, they feel like they aren't getting the care they deserve and will go to another doc until they get what they think they need. Then in a couple of days when they feel better, which they would have even without the pills, they say that doc helped them get better.

I'm surprised that this still goes on, with everyone seemingly knowing the harm antibiotics are doing to all of us, but I know it does. I'm always hearing someone going to the doc for a sore throat or a cough and they almost always end up with a prescription for antibiotics. Maybe some of them need it, but I'm guessing most of them do not.