How to: Replace unnecessary antibiotics with a good dose of empathy

A key component of antibiotic resistance is the over-use of antibiotics. We talk about this a lot in the context of over-the-counter antibacterial cleansers, but there's a doctor's office side to this story, as well.

When sick people come into a doctor's office, part of what they are looking for is psychological wellness. They want to feel like somebody has listened to them and is doing something to treat their illness. Sometimes, that means they ask their doctor for antibiotics, even if antibiotics aren't the right thing to treat what they have.

In the past, and sometimes still today, doctors go ahead and prescribe antibiotics almost like a placebo. It's hard to say no to something a patient really wants, especially when it's likely to make them feel better—just because taking anything, and treating the problem, will make them feel better. But that is definitely not a good thing in the long term.

At KevinMD, family physician Dike Drummond offers some really nice advice for doctors who are struggling with how to make a patient feel better, but also want to avoid contributing to the growing antibiotic resistance problem. What I like best about Drummond's advice: It starts with empathy.

If you have a major challenge working up some empathy one of two things is happening.

You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.

You are not fully present with the patient and their experience. In many cases this can be addressed by taking a big relaxing, releasing breath between each patient and consciously coming back into the present before opening the door.

Read the rest at KevinMD

Via Nick Bennett


    1. There are indeed plenty of inappropriate uses of antibiotics outside of the ones you might get from your doctor. I advise no use of any antibacterial anything – apart from a little bleach in the bathroom. When you get sick you want it to be with plain old every day bugs that have never seen any antibiotics of any kind. When we need our wonderdrugs to heal a patient it is a REAL BUMMER when they don’t work!
      Dike Drummond MD

      1. You don’t really need to add your name and web address to your comments since it’s already linked via your profile. Thanks.

  1. ‘Sometimes, that means they ask their doctor for antibiotics’
    In my experience the doctor is just as likely as the patient to drive this interaction. Doctors often don’t like to admit that there’s nothing they can do to treat you and that your visit will end up being purely diagnostic. 

    1. I agree with this. I have had doctors write a prescription even after I asked if they thought I had a virus, and we agreed that antibiotics were not effective against viruses.

    2.  Agreed Boris … docs want to help and sometimes writing a script and moving on to the next patient is the easiest thing – even though we all know it is not appropriate. Just remember that 1/3 of them are suffering from burnout every single day. They are toast. When that happens they will sometimes do the easiest thing just to make it to the end of the day.
      Dike Drummond MD

  2. I had mono many years ago.  I was given no drugs but got huge amounts of advice and sympathy from my doctor and his staff.  That helped more than an amount of unnecessary antibiotics.

  3. and this is why many people turn to magical voodoo healing such as homeopathy. Turns out that homeopaths are generally pretty good listeners and will “examine” patients with caring hands before giving magic voodoo pills that don’t do anything. But the listening, the caring, and the empathy are in many cases what the patient needed.

    Pity that when patients come in with something serious that NEEDS attention then the homeopaths only give empathy and voodoo sugar pills…

  4. Where I live, you will not be prescribed antibiotics unless your snot is green or brown.  Last time I got sick, I didn’t go in because my snot was not one of the magical colors.  Two days later I got taken to the emergency room because I passed out from dehydration.  Turns out I had pneumonia. 
    Never getting a prescription for antibiotics when I get a sinus infection has trained me to never go to the doctor when I’m sick.  There is a flip-side, that’s all I’m sayin’.

    1. IronEdithKidd is right. There’s totally a flip side.Not any horrible stories like hers, but my experience is that some doctors are always reluctant to give antibiotics unless I’m obviously very sick. Sicker than I ever want to be. To the point where, when I had bacterial infections in my lungs and sinus, the doctor was going to chase me out without until I started coughing so hard I puked in his office. “Oh. Okay. Now you look sick enough. I’m going to prescribe antibiotics.”Thanks, doc!Thing is, I probably would have ended up in an overstressed hospital system too, if it hadn’t been for that well-timed coughing fit. OTH, I’ve had antibiotics prescribed for superficial infections after a 10s inspection at the walk-in clinic. They were needed, maybe it was just that obvious, but jeez, Doc. At least give yourself time to sit down!It seems to be a very personal choice; my experiences vary immensely by doctor. Right now t seems like there’s an oversupply problem, but you can push it too far the other way and we, as a society, should be aware of the risks of doing so.

    2. Where I live, you will not be prescribed antibiotics unless your snot is green or brown.

      I’ve been coughing out butterscotch pudding every day since I was two. I used to get abx and they seemed to help briefly. Then I read that abx can have a temporary anti-inflammatory effect, which is why they sometimes seem to cure viral infections. The real secret to good health is to never leave the house or have any contact with other humans.

  5. The fuck is wrong with you people?!  When I need antibiotics for say, a strep throat, its because nothing else has worked and my throat is literally closing up while my puss covered tonsils and lymph nodes play merry havoc pumping my system with poison.  People have DIED from not getting treated for this with antibiotics.  I have to go to a doctor to get antibiotics, they do this little thing called diagnosing the problem, then I get my antibiotics and in about 3-5 business days I start feeling like a human being again.  This is the DOCTORS responsibility, I don’t need a fucking nanny-state-sympathetic ear I need the drugs to work so I can be a productive part of society again.  Please don’t fuck this up with the ‘gee people can’t possibly think and be accountable for their own actions, let’s step in and do it for them!’ attitudes and laws off my body please.    

    1.  People are dying more frequently because antibiotics are overused for people who have viruses or bad hayfever.  The “state” has done nothing to change this, it’s a medical problem.  Strep throat usually goes away in 3-7 days with or without antibiotics.  The symptoms you describe are not diagnostic for having strep.  This guy is a DOCTOR who’s being responsible. 

  6. There’s another element at play here – uncertainty versus certainty.

    Say “Ahhhh”, doctor says “OK, it’s a viral infection in the throat, it’ll have to run its’ course and compounded with seasonal allergy, it’s making you feel doubly miserable.  Take such and such, drink plenty of liquids, etc.”.  Now I know it’s allergies + virus, which makes me feel a little less helpless.

    My doctor is pretty damned cool and not just a pharmaceutical sales agent in a white robe, here’s an example of his thinking outside(ish) the box:
    For the clogged-up nose, he recommended pediatric Afrin, since the regular one is way too potent, no need to overdo it.  Then after a few days, he recommended laying the Afrin aside and taking a couple of Advils, their anti-inflammatory properties help open up the breathing passages.  Worked like a charm, with minimal expensive prescription stuff.

    Considering my lowered defenses, to discourage any opportunistic bacteria from taking hold in there, my doctor also recommended gargling twice a day with a solution of 1 part Listerine, 2 parts water.

    Finally, my doctor is also a myotherapist, so in the same consultation he cracked my neck and softened up my back muscles, aching from constant labored breathing.

  7. More reasons why overhauling the healthcare system is needed. I remember just wanting medication last November when I was really sick. Because I was in school, the university health services never did a diagnostic culture or test because it cost money. They were happy to prescribe me antibiotics, which I probably didn’t need but hoped would work anyway. I ended up with yeast infections and my sickness was probably viral. But as an exhausted and ill student, I fell into the trap of just wanting medication. It’s discouraging to think about how it was apparently considered normal for the doctors to not take a sample or grow a culture just because it costs more money. 
    edit: I was sick for a long time – I was at the doctor’s three times in total. I didn’t expect them to take a sample the first time, but when I continued to have the same symptoms, they probably should’ve.

    1.  surreality … yeast infections are just one side effect of antibiotics. We all fall into the trap of wanting to do something when we feel miserable. Just that chicken soup and a nap don’t feel like we are “doing something”.

      My article is an attempt to give docs language that help patients feel better when antibiotics are clearly not necessary. If they feel like they know something to say that will help (with an “empathy poultice” in this case) maybe we can cut down on inappropriate antibiotics and their side effects.

      Dike Drummond MD

  8. “We talk about this a lot in the context of over-the-counter antibacterial cleansers”

    We do but we shouldn’t. It isn’t like your soap has erythromycin in it. Almost all of these things have an antibacterial antifungal agent called triclosan. Triclosan is not used as a medicine. In that sense, then, it is more an antiseptic than an antibiotic and triclosan resistance does not raise concerns about loss of efficacy of medicines.

    1. While triclosan is not taken internally as an antibiotic, there is not evidence that it has any superiority to soap.  There is an association (not determined to be causal yet)  between increased allergies and  triclosan exposure in kids:
      There is a concern that increased antibacterial agents like triclosan in the environment will lead to increased multidrug resistant bacteria/plasmids in the environment.
      So while triclosan will still not be used as a medicine, it may lead to bacteria being resistant to other antibiotics.  And antibiotics are sometimes used for kids with bad hayfever.  So I think we should talk about it until the science proves otherwise. 

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