Lose Lose Situation

Everyone has heard of the win-win scenario but what about the lose-lose scenario.  Imagine I just got off the phone with an unhappy patient.  He has had a very sore throat and a temperature of 99 degrees Fahrenheit for 24 hours.   He “knows” he needs an antibiotic and can’t come in to be seen.

“Doc, I know my body.  When I get a sore throat, I always need an antibiotic!”

“Mr. A, the vast majority of sore throats at your age are caused by viruses.  Antibiotics don’t kill viruses.  In reality, the risks of antibiotics far outweigh any potential benefit at this time.  Give it a few days.  Gargle with warm saltwater, drink plenty of fluids and take acetaminophen if your temp goes above 102.”

“Doc, I can’t afford to be sick.  It will ruin my weekend.  I know I need an antibiotic!” 

My patient does not sound happy.  He is sick and convinced that nothing short of an antibiotic will help.  What’s a doc to do?  The easiest thing is to give in and call his local pharmacy.  After all, what’s the worst that can happen?  He could have an allergic reaction or an antibiotic-induced diarrhea, that’s what!

What else could happen?  Frankly, he could get worse!  If anything, antibiotics mayl assist the virus in attacking its host by wiping out the patient’s normal flora.  What else could happen?  

By prescribing an antibiotic inappropriately, I will reinforce the idea that my patient needs an antibiotic every time he gets a sore throat.  The odds are strong that he’s going to get well; and, if I’ve given in, he will attribute his newfound health to the antibiotic.

In a future world where doc’s pay is dependent on patient satisfaction surveys, Docs will constantly be faced with this lose-lose scenario.  Is my job to satisfy my patient or to provide evidence-based, appropriate medical care?

Making matters worse, some urgent care doc, whose job is dependent on patient satisfaction surveys, will likely see my patient this weekend.  He/she will likely give in quickly and prescribe the antibiotic that I refused to prescribe.  He/she will enjoy the win-win of pleasing the patient in a 4-minute visit and will not have to deal with the aftermath.  So goes the life of a family doc.

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