At the family practice where I work, my preceptor books patients every 15 minutes with a few last-minute emergencies squeezed in. I, on the other hand, see patients every half hour to allow for the fact that I'm still learning. Not to mention the fact that I'm still sneaking out of the examining room to look up drug dosages, fumbling though the sample closet for ages to find what I want and occasionally waiting for my preceptor to finish with his patient to confirm my treatment plan with him. So I take longer.
All in all, I'm seeing about 12 patients a day. Par for the course, according to my impromptu discussions with fellow residents during our academic half days. Out of those 12, at least 2-3 are coming in with a cold. Every single day.
Why on earth would anyone see their family doctor for a cold? I really don't get it. You have a stuffy nose, a cough and you generally feel like crap. And it's been going on for three days. What on earth do you think that seeing your family doctor is going to do? If there was a magic pill that cured the common cold, don't you think you would have heard about it by now?
So now I have a "spiel"-- I explain all the things that I can rule out based on the physical exam. No swollen tonsils with white crud on them? Not strep throat. Ears look fine? No ear infection. Lungs sound clear? Not a pneumonia. Then I go on to tell them that since there is nothing going on that we can treat with antibiotics, they just have to let the virus run its course. Usually people are okay with that, and if they seem to want more I'll perscribe a cough suppressant with slightly more codeine in it then you can get over the counter. Or a swish-and-spit mouthwash that is only slightly better than placebo at helping a sore throat. But it makes people happy.
My preceptor, after 10 years as a family physician, is slightly more accomodating. If people honestly think they need an antibiotic, he'll occasionally give it to them even if it goes against evidence-based medicine. I can understand the urge to keep your patients happy, but I also don't think that patients should dictate their own treatment. It may sound paternalistic of me, but that's why we train for so damn many years... so that we have to knowledge and the tools to make treatment decisions for them. Otherwise, ALL drugs would be available over the counter. My preceptor good-naturedly refers to me as The Antibiotic Nazi. At least, I'm hoping it's good natured.
But back to the point. Why do people come in with a cold? Do they honestly think it's something worse? Even if everyone in their family has a cold, they've had a cold in the past and there's nothing new and interesting about this particular bug? I can understand in the case of a child, because parents always err on the side of caution when a kid has a sniffle. And kids are much more likely to have strep throat or ear infections. But when a healthy 35-year-old comes into the office with a two day history of stuffy nose, cough and fatigue, I have to be honest and say that I'm rolling my eyes in my head...
Sigh. But that's what a family doc is there for, right?
Labels: family medicine