When you have a cold, I want you to know why I’m not giving you an antibiotic

This is from a family physician.  Trying to prevent antibiotic resistance.  We need to be especially careful about this. Please don’t always ask for an antibiotic,

I want you to know about colds, and integrity.

Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either.

Truthfully, as odd as this sounds, I wish could find something bacterial — something “curable” on your exam or testing. Not because I want you to be sick, but because I can “do” something. And frankly, a lot of the times it would be easier. If you have strep throat, I can give you an antibiotic, counsel you, and send you to get well.

Over 90 percent of all office visits, for cold or bronchitis-like symptoms, if lasting less than 7 to 10 days, are for a viral infection. That is a real, studied number: over 90 percent. Viruses, unlike bacteria, have no antibiotic that can “cure” you. The treatment is rest, supportive care (usually with over the counter supplements), and time. There is no pill or treatment that cures a viral illness.

These numbers can be difficult for your physician. Most of us joined this profession because we want to participate in the relief of suffering. Occasionally, we may feel that we are doing the opposite when you come in for your cold and we don’t prescribe an antibiotic. Maybe we feel, and you as a patient feel, that we did nothing.

When you have a cold, I want you to know why I’m not giving you an antibiotic. I want you to know that sometimes doing nothing is doing something. Sometimes, doing nothing is in your best interest.

When I see a patient for a cold, their visit takes more time for me than a straightforward case of strep throat or ear infection does. I take the time to explain the difference between a viral and bacterial infection. I explain that prescribing antibiotics for a cold provides no symptom relief, and adds the adverse risks of diarrhea, allergic reactions, and more. Antibiotics carry even more serious risks, such as Clostridium difficile diarrhea. Sometimes antibiotics are necessary and outweigh the risks, but if not necessary, it’s my job to protect you by not prescribing them.

If you come to me for your cold, however, I will do everything in my power to not send you away empty handed. I want to know what about your cold is bothering you the most and what you’ve tried at home. We will discuss honey, lozenges, salt water gargles, over the counter pain relievers and more depending on your symptoms. I want you to leave my clinic knowing how important it is to me that I provide you with relief.

I started my letter with the intention to not only discuss colds, but integrity. I’ve mentioned that outpatient viral illnesses, in general, take more time than simple bacterial infections for me. Physicians know what I’ve written. We know that over 90 percent of the time, with less than seven days of symptoms, normal testing and no signs of bacterial infection on exam, that you have a cold. We know that antibiotics do not serve a purpose in your cold. We know the risks of prescribing antibiotics for a cold. But I also know that sometimes, offering an antibiotic, a “cure” makes for a shorter visit, possibly less explanation, and that sometimes we send a patient home happier. We’ve done something.

For many of us, the choice is tempting. We want to send a patient home happy — to send them home feeling we’ve done something. It’s tempting to say, “Ah, here’s an antibiotic and you should feel better in a few days,” rather than to explain in depth why you don’t need an antibiotic. Giving antibiotics can shave time, and can improve your sense of trust in us. But I want you to know that what is easy isn’t always right.

I want you to know that as a physician, I feel a pang of insecurity, guilt, and sadness when a patient tells me they’re upset because I won’t write an antibiotic. I don’t want you to be sick or miserable. I understand how inconvenient and sometimes life altering a cold can be. I desperately, desperately wish that I had a cure for your cold, but none of us do. I also want you to know that for every antibiotic I over-prescribe, that I run the unnecessary risk of making someone even more sick, even to the point of hospitalization or death. I went into medicine to help you and to relieve your suffering with integrity — and that by giving you antibiotics without indication, I am betraying my own purpose.

I hope that you won’t ever catch a cold. But, if one day you do and your physician tells you, “antibiotics won’t help you, but let’s discuss some other options that might help,” know that your physician did not make that decision lightly, and they did it because they knew they were doing the right thing.

Disclaimer: THIS IS ESPECIALLY IMPORTANT FOR PI PATIENTS!

Symptoms and courses of illness change. Viruses are a predisposition to bacterial illness, so it is absolutely possible to go from a cold one moment, to a bacterial infection to the next. Please see your doctor if you have a concern.

Eileen Sprys is a family physician.

I feel your pain. I have a miserable virus right now – and it triggered an autoimmune flare. Nothing that meds can help.  Time, sleep and fluids.

Lets talk self care next time.

Later,

C