A disturbing and growing trend. Telephone medicine like this is just asking for trouble:
Already, though, says Dartmouth pediatrics professor James Sargent, there are many situations where doctors call in antibiotic prescriptions and refills “without cause for alarm.”For example, Sargent said via e-mail, his practice often calls in prescriptions for antibiotic drops for pinkeye and pills for sore throats in people who have a family member diagnosed with strep throat.
Randall Stafford, associate professor at Stanford’s Prevention Research Center, acknowledges that phoned-in antibiotic prescriptions are OK in some situations, such as for women with a repeat urinary tract infection. Still, he called Marder’s findings “concerning.”
“The standard of care is to have adequate information to make reliable decisions,” Stafford says. “Usually, that requires a physical exam.”
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{ 10 comments }
I have seen a lot of patients who have been treated for “pinkeye” with antibiotics. It is always fun to explain how the antibiotic they have been prescribed is ineffective for viral conjunctivitis or occasionally, equally ineffective for iritis.
I would love to know why that pediatrician thinks it’s OK to call in antibiotic drops for pinkeye, which is usually viral and resolves in 72 hours on its own.
Because “I know my patients, dammit!”
Bacterial conjunctivitis is more common than than viral in kids, really. So that idea is not crazy. Both conditions are usually self-limited. However, prescribing sulfacetamide or gent is not smart because of resistance. Something like vigamox will cure most bacterial conjunctivitis in 24 to 36 hrs, and is very safe. Of course the child may have iritis, herpes, retinoblastoma, etc. Good luck. A pediatric ophth.
A few years ago, I experienced the most excruciating pain in my left eye immediately on waking. This had happened before, over a period of 5 or 6 years. I waited until late afternoon to call my doctor’s office, because always before, the eye had calmed down within a few hours. I still felt as if I had a foreign body lodged in the eyeball, despite frequent and liberal use of eyedrops. The doctor told me firmly to go to the ER–not Urgent Care, the ER.
We ate our supper and decided that, rather than facing a 3-hour wait in the ER, we would go to UC, anyway. That was a mistake. The doctor there ordered a thorough lavage of the eye, which did not help, and then announced that, while I was thus occupied, she had consulted a book of symptoms and come up with an infection she’d never heard of (nor had I, of course). She prescribed an antibiotic ointment and sent me home.
No better the next day (a Friday), we went to the ER. I was seen by a phys. asst. after a wait of only about 15 minutes. He examined my eyes, took the history, went away to talk (ostensibly) to the doctor. Ten or 15 minutes later, a nurse came back with a diagnosis of pinkeye, and a referral to the ophthalmologist on call.
Still not satisfied, I called that doctor as soon as I got home, thinking it was time to consult someone who would know. Part of what bothered me was that neither diagnosis had taken into account any of the prior occurrences.
I saw the doctor the following Monday. She actually listened to all the history that I gave her and said she did not believe I had an infection. She gave me a pretty certain diagnosis, the name of which I don’t remember, but it sure did fit all of the experiences: From time to time, as I sleep the eyelid sticks to a too-dry cornea and, on waking, rips off a bunch of cells. Trust me, it feels as least as bad as it sounds. She recommended an ointment to be used nightly, at least for a while, and frequent use of a good fake-tears product (e.g., HypoTears). I used the ointment for several weeks, and have twice felt a need to use it for a few nights, since then.
I was pretty annoyed that neither of my other encounters was with someone who knew how to listen and how to consider that an easy answer might not really address the whole experience. Am I being too hard to them?
Jeez, we put tetracycline in pig and chicken feed, I think there are bigger problems than giving an anxious mom erythromycin drops for their cranky kids “pinkeye”.
“I was pretty annoyed that neither of my other encounters was with someone who knew how to listen and how to consider that an easy answer might not really address the whole experience. Am I being too hard to them?”
Why not go to an eye doctor in the first place, or even an optometrist. Also, they didn’t miss anything excricuiatingly important since your doctor prescribed you Artificial Tears, which also is mostly just a placebo like antibiotic drops. If you don’t have iritis, a corneal ulcer, acute anble closure glaucoma, ruptured globe, herpes keratitis then most of these eyc complaints are just silly things that go away with time or some placebo eye drops.
Vicky, the prev anon comment is correct, you should have started with an eye person( my bias , to an EyeMD rather than OD). The ER docs and staff are not too good with eyes. Also, if you are trying to give your history, and it takes more than a few seconds, expect the EyeMD to interrupt and motion to put your chin on the chinrest so he or she can see what actually is happening. When I started out, my cynical senior resident taught “the history is there to confuse you” and he was right about 95% of the time.
When you are a subspecialty surgeon or physician, history definitely gets in the way. I don’t want to know what any doctor or treatment you had before you got here, because if they were right you wouldn’t be here.
Anon. 1:25 and 10:27–Under our current insurance coverage, I would not hesitate to go straight to an ophthalmologist, bypassing the primary physician (as great as he is), UC, the ER, and the OD. But our HMO didn’t allow that.
I couldn’t even follow through with the ophthal’s instructions to return in two weeks; the OD that I had to see after I saw her said I didn’t need to. I tried to make an appointment to see her on a cash basis, but the receptionist said their contract with my insurer wouldn’t permit that.
This is a classic example of why I always choke, when I hear a commercial for an HMO: “See the doctor of your choice (from our long list of accepted providers, that is).” The ads never say that you can’t see a specialist without a referral.
We’ve just switched to a PPO. I plan to get some things taken care of that I couldn’t, under the old program.
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