Mom, dad and two-year old child. The child is the patient. He has a runny nose, mild cough, congestion, stuffy, cranky and intermittent fever. You know. A cold. I really try not to be impatient with parents. I figure they are doing the best they can and it’s hard taking responsibility for another human being, especially a tiny one. But this too falls into the category of “really?” Do you really think this needs to be seen in an emergency room at 10 pm?
I guess I was even more irritated because about two minutes after meeting this family, I discover they already went to their own doctor a day and a half earlier (almost exactly 36 hours.) Their doctor put the child on an antibiotic already. So they were seen, examined, evaluated and treated. But it has been a whopping 36 hours and omigod! The baby is not fully well and omigod! What should we do!
So let me tell you, from this small encounter, a few things that are wrong with our American health care system.
1. First off, medically speaking, this child did not need antibiotics. No way. No how. Wrong, wrong, wrong. This child had a cold, plain and simple. Colds are viruses. Viruses are not bacteria, so an antibiotic, which is another way of saying anti-bacterial, is utterly ineffective. Another time we will talk about the actual negative implications of taking antibiotics when not necessary. The implications are huge.
2. Their doctor undoubtedly put the patient on antibiotics for one of two reasons. Probably he was hurried, and it is so, so, so much quicker to write a ’script than talk to the patient, especially if the entire family does not speak English. Or he took the path of least resistance. Many if not most patients do not believe a doctor who says that antibiotics (or x-rays, or CT, or MRI or blood tests etc) are not indicated. So we doctors learn it is less painful to not have our knowledge base continually trivialized by patients. (I have been asked at least a thousand times in my career: “How do you know it is a cold?” Or similar.) Not to mention keeping the customer happy, even if it is not good for the customer. We Americans have decided that customer satisfaction is an important variable in health care. And customers want tests and prescriptions.
3. The other reason the doctor may have prescribed antibiotics is that the doctor has already internalized such a risk-averse view of the American healthcare environment, that s/he cannot even think competently anymore in this regard. Many doctors now practice as if the 1% chance of something is the likeliest possibility. As in “there may be a 1% chance this is bacterial, so I should treat it as such.” That’s pretty much how it goes, and it is hard to tease out anymore what the doctor really thinks is going on clinically, from his perception and fears about malpractice and patient satisfaction. The doctor is pretty unaware that these factors have wormed their way into his clinical judgment. Because after all, most doctors know a cold when they see it. Except apparently when they are wearing their own white coat!
4. No ordinary, typical people who have to pay actual money to go see the doctor would normally wasted their own time and money like this. In the rest of their lives, normal people make “normal” decisions, taking into account the time and money factor. But these days the norm is to make abnormally ridiculous decisions, which is to run to the doctor. In fact, if people hesitate to run to the doctor, their friends and family are quick to criticize. “Have you gone to the doctor?” So the over-utilization of really expensive resources, which the ER is, is rampant and “normal.” Literally, only one generation ago people did not act like this. Up until the mid-1980’s people did not do this. But then the law changed, and people have internalized that as the new “normal.” More about that law in another post.
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