Cough, Cough

03.26.14

Doctors Can’t Prescribe a Magical Cure for Everything

In the fight against antibiotic resistance, patients must understand: Doctors can’t cure everything with a prescription. It’s sometimes better if they don’t give you any medicine at all.

I am not a wizard. That probably does not seem like a particularly controversial statement on its face. As famous as the physician “god complex” may be, presumably nobody really thinks doctors have actual superhuman powers. I make diagnoses and prescribe treatments. I don’t exorcise demons, I don’t dole out potions, and I can’t cast spells. Unfortunately, it seems like some patients think otherwise.

Any day now we will come to the end of winter weather, and with it the end of cold and flu season. Though the “bread and butter” office visits for scratchy throats and runny noses help keep the doors open, telling an endless stream of nerve-wracked moms and dads that I can’t make their child’s upper respiratory tract infection go away any faster gets pretty wearying by late March.

Obviously, I don’t want my patients to have ear infections or strep throat. But the little glimmer of a silver lining for those problems is that I can usually cure them. A short course of an inexpensive antibiotic, and there’s a pretty good chance that my patient will be feeling better in short order. It’s not “good” news, but at least there’s something to do about it.

Those run-of-the-mill colds, though? Those I can’t fix. The coughs and runny noses and general malaise that come with them can only be remedied by time and rest and a functioning immune system. Nothing I can prescribe will have any impact on the viral infections that are causing these symptoms in the first place. If anything, the side effects of medication will simply make the patient feel worse.

Thankfully, most parents understand this. Every time I hear a mother or father say “I don’t want a prescription if my kid doesn’t need one,” an angel gets its wings.  Not only do these parents help me do my job right by fighting the rising worldwide problem of antibiotic resistance, they’re keeping their own child healthier in the long run.

Unfortunately, there are some parents who simply don’t buy it. Their child has been up all night coughing, it’s driving everyone in the house crazy, and surely there is something I can do to fix it.

After looking in the ears and down the throat and listening carefully to the lungs, if I don’t find anything I can treat, I start explaining the likely viral cause of the symptoms. Knowing how frustrating dealing with a sick child often is, I express sympathy at what a pain dealing with the illness must be and offer as many suggestions for helping them feel better as I can. However, given that over-the-counter cough medications are not recommended for children under the age of two at all and don’t work that well for anyone, there are often few things to offer beyond reassurance that things will get better with time.

Unhappy reactions range from a certain stoniness in the parents’ eyes and a terseness in their speech, to outright demands for antibiotics. “You’re not going to prescribe anything?” said with transparent skepticism is a common refrain, at which point I explain all over again why antibiotics aren’t indicated for the present illness and why prescription cough suppressants are a bad idea.

During these discussions, I often find myself wondering why the parent thinks I’m saying no. Do they think I reserve the prescriptions for patients I like better? That slipping me a ten spot will get the amoxicillin going? That I hoard medication and go to sleep each night on a big pile of Zithromax?

I do not prescribe antibiotics for children who have mild illnesses of short duration because I do not think they will work. Period. If I thought they would help, I would prescribe them. But given that over-prescription of antibiotics is making them less effective over time and can have dire consequences for some patients, doling them out willy-nilly is bad medicine. It is much easier to just scribble out a prescription without thinking, but doing so is lazy and poor patient care.

If there were something I could prescribe that would relieve all my patients of unpleasant symptoms when they came in to see me, I would gleefully dispense it. Unfortunately, medication can only do so much and has ill effects if used improperly, and medication is all I have to offer. I am not a wizard, and I have no magic.