How do you tell a patient that their doctor is incompetent?
We get scripts from a particular doctor in my neck of the woods about 2-3 times a day. He's a really nice guy, and he's about 80 years old. His scripts are always for the same antibiotic. Ampicillin: 500mg b.i.d. for seven days. Now that I'm working more, I've noticed this trend, and the disturbing tendency for these patients to come back a week later with prescriptions for different antibiotics, usually prescribed by someone at the ER. Probably as high as 50%.
Curious, I started conducting an informal Q&A to find out what this doctor was prescribing for. There are some head-scratchers among them:
- pneumonia
- UTI
- GI infection of unknown etiology
- sinus infection
- ear infection
- H. pylori
- Acne
Sure, you might use ampicillin for an ear infection. Maybe even a sinus infection. But pneumonia? Probably not. It's also an unlikely choice for UTI — yeah it's got some activity against Proteus, but is it really the best choice? Acne? Hmm…
I might be inclined to give him the benefit of the doubt; we certainly get some head-scratchers sometimes, and they usually work out okay. If we call an office, we usually get a reasonable explanation. But this is the only antibiotic this guy writes for. Ever. Quinolone? What's that? Cephalosporin? Who needs it! Macrolide? Hah!
I don't mean to be a smartass, or to disrespect this guy, but I've never seen a script that shows any amount of cognitive effort behind it. It's always ibuprofen 600mg t.i.d. or ampicillin. Usually ampicillin.
I'm trying to come up with a nice way of telling people this probably won't work very well for your condition and more importantly, you need to find a real doctor. When does it become my business to get involved? I worry about things like our MDRO problem. I don't like to see patients have to go to the ER when it's totally avoidable. Does being nice make up for not having a clue about modern treatment paradigms for bacterial infections? Should I not tell them that they're probably wasting their time and money?
[tags]Medicine, pharmacy, antibiotics[/tags]
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I took over for a retiring doc who did the same thing with keflex. Same results too.
What happened when i took over and made more rational decisions? People asked for the Keflex.
Comment by DrSteve — November 29, 2006 @ 5:21 pm