Expectations Trumps Exam

By symtym | 12.7.06

Study: Doctors call in more antibiotics without exams | USA Today | 12.6.06

Prescribing antibiotics has become so common that many doctors literally are just phoning it in, a new analysis of insurance claims suggests.

Patients who received at least one antibiotic
prescription without visiting a doctor.

Age %

0-5 25.1

6-12 23

13-17 34.5

18-24 42.2

25-64 45.8

Patients who received at least one antibiotic
prescription without visiting a doctor.
Age	%
0-5	25.1
6-12	23
13-17	34.5
18-24	42.2
25-64	45.8

Of course the implication is that antibiotics are given indiscriminately because there was no exam. How many are given indiscriminately with an exam? I’ll bet there isn’t much difference; which begs the question—are antibiotics given based upon need or upon expectation? Patient satisfaction? JCAHO satisfaction? Press Ganey satisfaction? Litigation avoidance? The exam is much overrated when you consider all the eyes and all the ways physicians are scrutinized. Antibiotic overprescribing is a symptom of an underlying complex condition that plagues healthcare. Trivializing the problem to whether or not an exam was conducted is truly an ostrich in the sand approach.

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universalhealth 12/08/2006 03:14 AM 1 point
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Yes to all of the above reasons and to add to them: employers' expectations that workers come to work when ill (presenteeism), parents' inability to take time away from work to bring children in for office visits, delay in getting office/clinic appointments, decreased availability of school nurses to see children with acute symptoms, attempts for primary providers to see as many patients as can be crammed into the clinic/office schedule, little risk of acute harm for extant practice.

Does anyone still use the self-assessment diagnostic tool to distinguish viral from bacterial caused URIs?

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