March 2000 • Volume 6 • Number 3
A pill that cures every ill? Tell patients: Not gonna happen!
When a patient demands unneeded antibiotics, sometimes you just have to say no. But you can soften the blow with a good dose of education, according to family physician John Hickner, M.D., of East Lansing, Mich.
"Patients are most satisfied when their doctors listen to them and provide them with access," he said. "I'm seeing more patients who accept my explanation that they don't need antibiotics."
So what should you do if a patient demands antibiotics?
First, "get behind the patient's demand," said Hickner. "Why are they demanding it?" If the request is based on misinformation, spell out the facts about viral vs. bacterial infections and explain the risks involved in taking unneccesary antibiotics.
Next, offer suggestions for treating the patient's symptoms, such as over-the-counter remedies, more fluids and rest. If the patient remains unconvinced, Hickner said you have two options.
Just say no. "You can tell the patient, 'It wouldn't be good medicine for me to provide an antibiotic. If you don't get better, give me a call and let's talk about it,'" said Hickner.
Or prescribe drugs -- with a caveat. "Some doctors are writing a prescription and telling the patient, 'Just wait a few days to fill the prescription and see if you get better,'" Hickner said. If you opt for this solution, write a time-dated prescription (so the patient doesn't save it for the next time he's sick) and choose a basic, narrow-spectrum antibiotic.
Regardless of your approach, you might appreciate a little help. The CDC offers an abundance of resources on a section of its Web site called "Antibiotic Resistance: A new threat to your and your family's health." Just surf to www.cdc.gov/ncidod/dbmd/antibioticresistance/. The site also includes an order form with many free patient education materials.
And if you need a refresher course in antibiotic resistance, download the slide presentation or check out the other resources for health care providers.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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