Like most primary care providers, family physician Eileen Sprys sees her share of snotty noses, hacking coughs, and sore throats. And like most of us on the front-lines of healthcare, we know that an antibiotic will not cure what, at least for now, is incurable:
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.
Instead of quickly writing a prescription for an antibacterial medication that she knows won’t work on viruses, Dr. Sprys spends a lot of time explaining to her patients why she isn’t prescribing an antibiotic in these cases. “Sometimes doing nothing is doing something,” writes Dr. Sprys. “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.
Dr. Sprys offers her patients the usual suggestions for symptom relief — honey, saltwater gargles, over-the-counter pain relievers — while drawing a line that maintains her integrity and upholds the oath she once took: “Primum non nocere”: “First do no harm.”
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.
Of course, viral infections can lead to bacterial complications that usually require antibiotics for cure. During sick visits to assess infectious complaints, much of our time is spent searching for bacterial causes of illness, a relatively easy explanation, and a quick “fix.” When we fail to diagnose a treatable microbial condition, Dr. Sprys reminds us that doing “what is easy isn’t always right.” We know if we diagnose your child with a viral illness, being wrong will add to their suffering. No pediatrician, parent, or child wants that. On the other hand, no pediatrician wants to cause harm to their patients by recommending a treatment plan they know won’t work. Sometimes doing nothing is doing something.
Dr. Kristen Stuppy adds a valuable perspective as a patient and a pediatrician here.