Tip o' the Month - January 2024

Happy New Year! This is the first Tip o’ the Month for 2024.

I would like to kick things off by following up on the theme introduced in December--managing requests for antibiotics when they're not clinically indicated. This is particularly relevant in the primary care setting, and it’s not a novel situation.   

The patient, parent, son, daughter, or caregiver has invested their time and finances in a medical evaluation. Often, they expect a tangible solution, like antibiotics, for infectious illnesses. If your clinical judgement is that the etiology is viral or if point of care testing (POCT) confirms a viral cause, then antibiotics are not an appropriate treatment at that point in time.

However, many laypersons are not educated in this science. Yet, their concerns about their own health or that of someone they care about are valid. This should not be denied, nor dismissed.

In fact, I would argue that, as caring clinicians, we are bound to respect and validate their concerns. And, as one wise clinician once told me, we should praise and validate their diligence and intuition to seek early medical care. Consequently, we have created the underpinnings of a collaborative approach upon which we can guide and teach.

Here are some suggested guidelines to offer instructive care with these types of cases:

• Recognize and validate the symptom complex.
• Distinguish the critical differences between bacteria and viruses which make bacteria susceptible to antibiotics and viruses immune. Although the patient is ill and symptomatic, evidence has taught us that antibiotics will not help if the cause is viral. Indeed, they could even be harmful to the patient and to the community in terms of antibiotic resistance.
• Discuss a collaborative treatment focused on symptom-relief, strengthening the immune system and, as appropriate, the use of anti-viral medication.  
• Set up a mutually agreeable follow-up plan including education about the signs and symptoms of secondary bacterial infection. Discuss the treatment options in case this occurs and clearly outline the follow-up steps.
• Record your plan of care in the notes so that colleagues are seamlessly able to step in if you are not available. I also suggest that there is a contingency plan in place to adjust the treatment plan appropriately without the patient/caregiver needing to pay an additional office visit charge or take more time away from work or family responsibilities. Telehealth may be an appropriate follow-up option.

The above approach aligns with our medical training and respects patient concerns. Yet, sometimes, patients or caregivers may still not be satisfied, and we have to let that go. You will, however, have provided ethical and compassionate medical care to the best of your ability.