A doctor equivalent of fizzbuzz could be “what do you prescribe for a viral infection with no indication of a secondary infection” and from what I’ve heard there are a lot of doctors failing that one during the COVID pandemic by prescribing antibiotics.
Yeah, just look at the number of people that demand antibiotics, even if a doctor thinks its viral, and the number of doctors that capitulate to those demands.
> I know when I need antibiotics, or I have a strong hunch, I just need them to confirm and write the script (They do this over apps now).
Frequently people do not know when or if they need antibiotics. People often end up taking antibiotics for viral infections (which do nothing). The CDC points out that taking antibiotics for viral infections can do more harm than good [1] and this leads to antibiotic resistance [2]. It's pretty unlikely a doctor would prescribe you antibiotics for a viral infection, certainly at the population level. This is why they're in the loop.
There's a lot that goes into prescribing antibiotics. For instance, do you have a bacterial, viral, or amoebal infection? Is it gram-positive or gram-negative? Broad-spectrum antibiotic or targeted? Is it worth the potential risks to your gut health? [3] How about side-effects and contra-indications? What if you have something else entirely?
Doctors are overwhelmingly not the reason that this happens. Some are being risk averse (heading off unlikely 2ary bacterial infections to prevent lawsuites) and some are taking the path of least resistance with patients (who will doctor shop until they get some medicine).
This is just my firsthand experience with doctors and anecdotes. _Every single doctor_ is aware know the (lack of) efficacy of antibiotics against viral infections. I'm am completely comfortable with the blanket assertion, and I'm pretty sure you are wrong if you think otherwise.
> Doctors throw antibiotics at viral infections as a placebo cure _all_ the time.
A fact pulled directly from your ass. Doctors never prescribe antibiotics for viral infections; antibiotics are for bacterial infections and no they don't just hand them out willy nilly.
Why prescribe it if we know it is viral? First, the doctor should determine whether or not it is viral or bacterial. If it turns out that it is viral, then DO NOT PRESCRIBE ANTIBIOTICS. Is it because of placebo? Because if so, the costs are too high. Tell them to take zinc or whatever for a week.
> Doctors throw antibiotics at viral infections as a placebo cure
That's actually not what doctors say. When they can't determine if an infection is viral or bacterial, they treat it on the chance that it's bacterial (since we have a known treatment for bacterial infections and don't usually have a treatment for viral infections).
Tonsillitis is a good example: About 50% of tonsillitis cases are viral and 50% bacterial. "Relying on clinical presentation and history alone is unreliable in differentiating streptococcal from viral tonsillitis."[1] And bacterial tonsillitis can be quite serious.
So it seems reasonable to go ahead and treat with antibiotics even when there's a 50% chance that it's wasted, because the other 50% chance was that the treatment was highly beneficial.
I have a hard time believing that both a doctor would administer antibiotics for coronaVIRUS and that antibiotics would be of any use there.
Edit: Children comments are pointing out the antibiotics could be for secondary infections. Fair enough, but the parent comment's implication that the antibiotics helped with coronavirus recovery is what's problematic.
I'm Norwegian. Norwegian doctors at least used to be extremely careful about anti-biotics. I now live in the UK, and the doctors here often prescribe anti-biotics after telling us we most likely have a viral infection.
I think the main thing is to challenge them to explain why. If they can't give a coherent explanation, ask them to explain to you what they think the risks are of waiting.
Most of the time when doctors here want to prescribe anti-biotics their answer is pretty much "just in case I missed something and it's actually a bacterial infection", and usually they'll then concede that if I'm ok with it, I can wait it out a couple of days and only take antibiotics if things doesn't start to improve with minimal risk. A couple of times the explanation has been that they've often seen specific symptoms exacerbated by a simultaneous bacterial infection, but again their response has been the same: if I don't keep getting worse, I'm fine to wait.
The only time I've ended up taking the antibiotics on offer was when I came in once spitting blood and with massive white lumps at the back of my throat (from whence the blood came, as they were ripped open when I coughed). Yay. Even then the doctor assumed, probably correctly, that it most likely was a viral infection that was making the rounds - she had a steady stream of the same symptoms that week -, but pointed out that given that my throat was so swollen and painful that I could hardly even drink, and the coughing of blood, if she was wrong and it got worse without antibiotics, next stop might be the hospital.
But of course few people care - they don't question the reasons for prescriptions at all.
Part of the high level of prescription of antibiotics in the UK is because of the health system here - they're paid per roughly per patient (adjusted for patient age, morbidity levels in the area they operate in, and a number of other factors meant to adjust for the cost of providing service, but the point is they are not paid per patient visit). If they get me out the door quickly and I don't come back, that's a win for them, so they are incentivised to get me well, but there's no downside to them short term from doing so by prescribing me something there might only be a 5% change that will make a difference to me at all - that's five percent fewer repeat visits at no real risk to them.
Few patients will complain, as the prescription cost is low, and when they get better in a few days, many of them will assume it was the antibiotics and so assume the doctor was right.
It's hard to set rules that prevent these kind of incentives, other than monitoring of whether or not they are in line with guidelines and/or whether or not they prescribe grossly more than the baseline.
From conversations with medical professionals: Antibiotic “misuse” is one of the most frustrating things in the field. They’re taught about antibiotic resistance in school, but then contribute to the problem by overprescribing it. The y describe the circumstances that patients (and parents) just want “a pill” to solve “a problem”, and that while the doctors know that it’s a viral infection, they still prescribe the antibiotics to placate the patient/parent. Further compounding the problem.
They’d be better just prescribing placebos or “drink some ginger garlic tea and rest”
Doctors are learned professionals, and they have a professional responsibility not to prescribe ineffective medication. Importantly, antibiotics come with their own substantial risks. A whiny patient is not a good reason, and I've never met a doctor unwilling to turn down a whiny patient. It's only at the margins where a whiny patient can cajole a doctor, such as to increase dosage. Plus, whining is one piece of evidence used in diagnosing, and if the doctor has others reasons to believe there's something substantive, whining can nudge him along.
The _crux_ of the issue is that doctors prescribe antibiotics for viral infections because the diagnosis is usually only based on a cursory examination. Their time is expensive, and you can't spend an hour on every patient with a cough and a fever. Furthermore, viral infections often precede or are concurrent with bacterial infections. So doctors are making a rational decision when prescribing antibiotics, and it's not even clear that this decision is globally suboptimal because bacterial infections are not uncommon with a cold or especially a flu.
If we're serious about overprescription of antibiotics, we should be heavily investing in improved diagnostic equipment and processes. For example, rapidly scanning mucus samples for viral and bacterial markers. The fact that we don't appear to be doing this suggests that either overprescription isn't actually a problem, or that we're not thinking seriously about the problem.
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