Monday, January 28, 2008

Kids Are to Placebos as Patients Are to...

Little children are placebo happy. If they have a small scratch, bump, or bruise that they can see they want a band-aid and a kiss. As soon as the band-aid is applied, the kiss given, they suddenly feel an instantaneous relief. If they’ve received medicine in the past for an illness they want something for their cough – or just to be like mommy and daddy. As soon as they get it, they’re happy. They're cured.

Patients are a lot like little children - at least the ones who use primary care services or the ER for minor complaints and an overt sense of entitlement. If you tell them that they’re going to be OK and try to send them along their way they get all upset.

“What, you’re not giving me an antibiotic? But I WASTED $25 for my stupid copayment! I didn’t come here to waste my money!” (as if taking up a professionals time and utilizing many years of education and training could be considered a "waste")

So, some doctors give in and prescribe the antibiotic, only reinforcing the patient’s misplaced sense of entitlement. Unlike a band-aid or kiss, this practice is dangerous as every drug has side effects and also increases resistance of normal residential bacteria.

Essentially the patient has thrown an adult temper tantrum, demanding to receive their placebo. Hell, we could give them sugar water with red food coloring and call it an antibiotic and they’d swear that they only get better with drugs.

In fact, my grandmother once told me about one of her friends who will purchase a large bottle of penicillin whenever they travel to Mexico. He then uses them with every subsequent cold he gets. I can't even begin to describe how irresponsible that practice is - I'm surprised he hasn't gotten a severe infection yet. But I'm sure he believes he improves only as a direct result of the antibiotics he takes and thinks his doctor's an idiot.


Anonymous said...

I think it is interesting that you have chosen anesthesia as your specialty - the management of pain issues being one of the few areas of medicine where the physician has to simply trust the patient to report their pain since there is no objective test to prove it. Have you thought about how you will manage when a patient reports pain (and i'm not speaking of one of the flat out easy to spot drug seekers) but you feel you have treated them adequately? If you, using your prior experience and all of your knowledge don't feel they need more meds despite what they are telling you - what will you do?

I just think it is interesting that you chose to practice in one of the few settings where the physician has to seek guidance from the patient, because it seems from the tone of many of your posts that you appreciate medicine because the patient seeks the guidance of the physician.

just curious

MSG said...

The patient needs to seek guidance from the physician...and vice versa. I'm not going into pain management, but I do understand that pain exists, in various forms. A post is forthcoming about this topic.

Anonymous said...

I just wanted to share, I moved from a major city to a rather rural area. I have an ongoing health condition and i had to utilize the local er for care. It sucked balls!

Well, it looks like I will be going back to the local er because that's the only place I can receive comprehenisve care, instead of piece meal here to there. My opinion of the Er has changed drastically. Now, living in rural america, there just aren't options. I also have pretty good, yet expensive insurance deductibles.

So, sadly, sometimes you gotta use your resources. If I was in "METRO" I would have been diagnosed and treated already.

Margaret said...

I absolutely believe in the placebo effect. I have no idea, scientifically, whether 800mg daily of vitamin C is doing me any good, but I feel better when I take it, and have done so for many years. I call it my 'voodoo' medicine.

I would never, ever get upset if my doc said I didn't need medicine for whatever ailed me. I'd be relieved!

Old MD Girl said...

I think one of the reasons people act this way is that doctors really DID used to give out antibiotics at the drop of a hat. It's what people expect. And plus, it's not very satisfying to be told, "Don't worry, it will go away on it's own over the next two weeks." TWO WEEKS! Who has time for THAT!

Ms. Printed said...

In situations like these, you have look your patient dead in the eye and give them the "I'm God, you're not" stare. Then pull from your coat pocket a textbook picture of super staph gone super bad. After seeing that, I'm sure they will be more than happy to praise your diagnosis as well as not waste more of their precious money on needless drugs.