â€œI think I have bronchitis. I probably need some antibiotics.â€
All primary care doctors hear that phrase very frequently. A patient develops a productive cough that lasts for several days, malaise, and slightly elevated temperature. Then the patient sees her physician with a clear and predetermined expectation of the correct treatment â€“ antibiotics. Knowing that antibiotics are not indicated for acute bronchitis, the physician is then forced to balance practicing appropriate evidence-based medicine with satisfying the patientâ€™s expectations. To some extent, this dilemma of physicians is self-inflicted. A generation ago, antibiotics were routinely prescribed for acute bronchitis, and an entire group of patients have therefore grown up misinformed by previous physician practice. The myth that green phlegm necessitates antibiotics also became well-entrenched at that time, leading patients to think that they are being prudent by only demanding antibiotics when their phlegm becomes colored.
Many unseen problems arise when patient expectations deviate from good medical practice. Unnecessary antibiotic use leads to increasing bacterial resistance, which is now a serious global problem. Antibiotics can also sometimes cause serious side effects. But perhaps the most subtle problem is that taking unnecessary antibiotics strengthens the patientâ€™s perception that this is the correct treatment. The patient would have recovered at the same time regardless of whether any medication was prescribed, but when recovery follows an antibiotic course, the belief that one caused the other becomes unshakable.
Iâ€™m certainly not advocating a return to the bad-old-days when physician authority and paternalism ruled supreme and patient preferences were disregarded. Iâ€™m just suggesting that the best care is delivered when the doctor listens carefully and the patient has an open mind.
To that end, hereâ€™s a wonderful (and short) review of acute bronchitis written for patients.
Two bad trends in our society, our increasing litigiousness and our increasing faith in the potency of vitamins, collide to produce this ridiculous story.