Prescribing antibiotics continues at high rates despite repeated studies showing the dangers of over-usage. Each year, 60 percent of sore throats and 73 percent of bronchitis cases are treated with antibiotics even though most of these cases are caused by viruses. It has been suggested that only 10 percent of sore throat cases warrant antibiotic usage. This issue is more complicated than merely doctors’ negligence — it is the consequence of a complex assortment of factors including patients’ expectations, insufficient tests and time limitations. The rise in antibiotic usage might be the best indicator of what little patience remains in 21st century doctors and patients.
The frequently misinformed general public influences physicians to make unprofessional decisions. The traditional belief that bacteria are the sole cause of infection neglects viruses, which are an equally likely cause. Indeed, antibiotics work to destroy bacteria but they have no effect on viral infections. Thus, when a patient is sick, there must be an understanding that an antibiotic will not always be of aid. But this does not keep some patients from begging doctors for these prescriptions, and doctors often attempt to quell their patients’ concerns. The drugs, more often than not, have few short-term consequences. But, this ignores the overwhelming research that shows the consequence of antibiotic usage for the general public. One of the greatest fears is the expansion of antibiotic resistant bacterial strains, that will someday become entirely untreatable. For example, MSRA, methicillin-resistant Staphylococcus aureus, is a well-known example of an antibiotic resistant infection. Perhaps doctors’ lack of patience to explain to their patients the overwhelming research supporting this notion causes doctors to sign scripts and move on to continue their busy schedule.
“It’s a lot easier to write a prescription than to have a five-minute conversation about why antibiotics aren’t necessary,” said Jeffrey Linder, a researcher at Brigham and Women’s Hospital in Boston.
Overbooking, walk-ins and other unexpected occurrences do not allow time for this conversation — the unfortunate and often forgotten part of the medical field is that it is indeed a business.
As doctors choose not to forfeit valuable time explaining to patients antibiotic consequences, patients demand an immediate fix. Up to this point, viral and bacterial testing has lagged behind other medical advances by primarily focusing on identifying known pathogens. Pathogens not recognized by sophisticated rapid testing devices provide null results. New tests continue to be unveiled that promise to provide quicker testing of blood to evaluate the immune response and subsequently the cause of infection, which address the previous problem of false diagnosis. As symptoms of bacterial and viral infections tend to closely mimic one another, symptoms alone make it difficult to determine the cause of infection. Waiting for the results of lengthy tests, and in the meantime, suffering from an ailment destroys patient satisfaction and heightens their desire to seek medical advice elsewhere. When spending money on a large copay, a surface examination does little to satisfy a patient and leaves them feeling that they have not been properly cared for. Patients must return to work or school and want something — anything — that has a chance of making them feel better. The potential long-term consequences are dismissed in their desire to heal quickly.
Doctors are not and will not be our ultimate healers. Allowing for nature to run its course must be accepted as an alternative to doctors writing prescriptions or for patients seeking a quick remedy. Sometimes the best care is, in fact, what seems to be no care at all — natural healing. In some cases, no fancy prescription drugs are needed, but a happy dose of patience will be the cure.
A version of this article appeared in the Thursday, Oct. 10 print edition. John Santucci III is a contributing columnist. Email him at [email protected].
