Thursday, November 02, 2006

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, 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.


Anonymous said...

Maybe there should be a placebo antibiotic.. ;) It should be really cheap, so the patient can be happy that the doctor is not only giving them what they need but saving them money as well.. ;)

My doctor always takes the time to explain but really he doesn't have to talk for long - all he says is this is a viral infection and antibiotics won't do any good, but I can tell you you some other stuff to use treat the symptoms of it.

The Curmudgeon said...

My late mother didn't think you'd been to the doctor unless you got a prescription. If her doctor didn't give her a prescription, the doctor's wife (who doubled as the receptionist and was a friend of my mother's) would give my mother a handful of samples of one sort or another.

Yeah, I know it's not right -- but there's a lot of people out there who feel just like my mother....

Anonymous said...

Hmm, I'd like to see the actual study. I wouldn't think that the average patient who went in with the idea of needing an antibiotic would be satisfied if s/he didn't walk out of the office with a script for something. :)

Anonymous said...

The problem goes back to the 1930s, when resistance to sulfa drugs was noted as a growing problem within a few years of their discovery (before penicillin was widely available). If only people had paid attention then, we might have staved off MRSA and other resistant bacteria -- as it is, we're in big trouble. Tom Hager

Anonymous said...

Send them on their way with a few Vitamin C tablets or a Flintstone's chewable. Whenever I go to the care provi--dammit, the DOCTOR, and he prescribes an antibiotic, I ask if it's really necessary or if it's just going to be the difference between feeling better in 3 days or 5 days. If it's really necessary, I'll take it. Otherwise, I decline. Why put shit in me if I don't have to?

It's me, T.J. said...


I'm really glad you understood what I was talking about, and that you also had the "big words" to put with it.


Client education is a very time consuming process. And as we all know, the client doesn't always remember everything they were told in the office visit anyway. Which leaves a lot of room for improvisation concerning what the doctor said during the visit.

I think printed handouts are very handy and informative. They also give the patient time to aborb the information. Mostly because they are able to read it over several times, or even share it with family members if necessary.

Nurses and other medical support staff can be leveraged as well for helping in these important matters, and can also free up the doctor's time so that he can see more patients.

I think that all doctors should have an office web page that has a basic Q & A page with things like:

*Sometimes your doctor will not give you a prescription for antibiotics. Why is that?


(This one is a pet peeve of mine.)

*Why should you take all of the antibiotics that your doctor has prescribed, even after you have started feeling better?


Thanks for the link Dr. A.


Anonymous said...

I just go to the doctor to get the free lollipop they give away at the front desk. Who knew I could get antibiotics too?

Dreaming again said...

My children have this nasty habit of getting strep.

I'm on immunosuppresion therapy.

Doctor's are unavoidable.

I am EVER so grateful when a doctor tells us that it is NOT strep and therefore does not NEED antibiotics.

I go in praying that we are leaving empty handed.

But then, there were too many years where everytime we stepped foot in the doctor's door it was with positive strep test and antibiotics on the way out. It's such a relief to not get them.

I'm not usually as lucky as my kids.

Anonymous said...

It isn't just antibiotics. Most people feel cheated if they leave the doc's office without a prescription. And doctors seem to have fallen right in line to oblige. The truth is, if a patient does NOT get a prescription, he'll probably find a different doc for himself!