Quid pro quo

I just read TJ's comment about yesterday's post and I found it very interesting.

I believe that antibiotics are over prescribed in many cases; but at the same time, I also feel that many times people go to the doctor unnecessarily as well.

And since they do show up in the doctor's office, I think that pressure is then applied to the physician to make sure that the patient leaves the office with a prescription in their hand. Mostly because the patient expects to leave the 'establishment' with *something*.

Kind of like a "thanks for your business" kind of thing.

Of course, I'm sure that Dr. A doesn't do that.

Now, I may be accused of interpreting this as "a joke," but this comment brings up an interesting point that I wanted to address. According to dictionary.com, the definition of quid pro quo is something that is given or taken in return for something else.

Something physicians talk about a lot is patients expecting to receive an antibiotic. Something physicians do NOT talk about is their tendency of writing for an antibiotic instead of explaining the rationale for holding off. Less than two months ago, there was an article in a prominent primary care medical journal that sums up things very well.

In one study, up to 50 percent of parents had a previsit expectation of receiving an antibiotic prescription for their children, and one third of physicians perceived an expectation for a prescription.3 Because of these expectations and the time constraints on physicians, prescribing an antibiotic may seem preferable to explaining why an antibiotic is unnecessary. However, researchers have found no association between receiving an antibiotic prescription and satisfaction with the office visit. What does impact satisfaction is whether patients understood their illness after the visit and whether they felt that their physician spent enough time with them.

So, in a roundabout way, I'm saying, yes, some doctors, for whatever reason, decide to write for the antibiotic. I agree with TJ that some docs see it as a business move ("If I don't give them the antibiotic, then they will switch doctors to someone that will.") Some see it as a way to save time ("I'm running two hours behind. And, if I write for the antibiotic instead of explaining why not, then I can keep from getting further behind in my schedule.") Or, some other reason.

Update: Kevin, MD linked to this follow-up post as well (Thanks! That's two days in a row for me.). He also said that I "hit the nail on the head." (aw shucks). A couple of interesting comments on his site to check out.