Posts Tagged Consumer Reports

Say “NO” to antibiotics but then what?

cougherKudos to Consumer Reports for the article on the over-use of antibiotics “How to Stop a Superbug” in the August 2015 issue.  One of the most common reasons people see primary care doctors is cough.  And, as it turns out, most of those coughs should NOT be treated with antibiotics.  Of course, it does not mean they do not need treatment — just not with antibiotics since the cause is usually a recent viral infection.  Antibiotics do nothing for viral infections.

Doctors who inappropriately treat a cough with antibiotics often do so just to get the patient out of the office as quickly as possible.  Statements like “could be early pneumonia” or “I hear some pneumonia” or “you have bronchitis” is the politically correct version of “you will get over it, take this pill and don’t bother me”.

So what is going on?  A virus irritates the lining of the bronchial tubes.  The tubes become inflamed and overly sensitive, causing the symptom of coughing.  Coughing is bothersome, it keeps people awake at night, makes noise at work and after a while it hurts the ribs and chest — it’s super irritating — please get rid of it!

The bottom line is that a virus infection causes a temporary form of asthma.  Doctors have hesitated to make that diagnosis because once you say “asthma” it is like a life-long diagnosis — in fact, it could have been a reason for an insurance company to deny coverage in the past.  So, by avoiding the “a”-word adequate treatment is not offered.  Anti-asthma treatment really works! and it is almost always a temporary treatment (unless the person really does have typical asthma).

Why a researcher would do such an experiment is not clear but they have compared the benefit of antibiotic treatment versus an asthma inhaler for “acute bronchitis” and found the inhaler works better — duh — treating a virus with an antibiotic is a placebo treatment.

Cough after a viral infection, particularly influenza, can last a long time, sometimes months, even though the virus itself is gone.  And, when people have a long-term cough other diseases need to be considered.  A cough that lasts for more than a few weeks usually needs to be evaluated with a chest x-ray as a precaution.

Many times a long term cough is the result of ineffective treatment — the failure to prescribe adequate inhaled medication to begin with.  Sometimes, it is the failure of the patient to have the prescription for the inhaled medication filled (it’s expensive) and sometimes it is a failure to take the inhaled medication correctly.

Very few doctors explain how to take an inhaled medication — it just takes too long, and they expect the pharmacist to do that.  Sadly, the pharmacy tech who hands out prescription has no idea how an inhaler should be used — and the pharmacist is not much better.  Proper technique (click on the link) is critical for the medication to work.

What inhaler is best? — there are several to choose from.  Check your insurance formulary for a combination product containing both a steroid and a bronchodilator.   There are no generics in this class of prescription drugs and that is another story!  Some choices include Dulera, Advair, and Symbacort (there may be others depending on what country you live in).

Again, thanks to Consumer Reports.  But, they did omit the obvious question for a cough:  if you don’t take an antibiotic for a cough, exactly what do you do?  If it’s mild, cough-drops and nasal decongestants are helpful, but if it is a bigger problem an anti-asthma inhaler is often a huge help.  Be proactive, tell you doctor you don’t want an antibiotic for your cough but you do want an asthma medication — bring this article with you.

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It’s Your Life at Stake in the Hospital — speak up

cc-speakup

Hospitalization is dangerous because of your illness and because poor communication increases the risks.  The simple fact is:  patients who speak up get better care than those who are quiet and unassuming.  As Gomer Pile’s sergeant would say:  I CAN’T HEAR YOU!

A recent article in Consumer Reports (CR) February 2015 “How Not to Get Sick(er) in the Hospital” puts a focus on communication in the hospital and is worth reading.

CR makes some good points:

  • You should be treated as a partner with the health care team.  As a partner you should expect explanations in language you can understand.  You should expect to know the plan, when and why tests are done and what results mean.  If x-rays or blood tests are done ask the doctor “what was the result”.
  • You should not be a silent partner.  If you are not getting information or do not understand what is going on you are risking your life.  Be courteous but speak up and ask questions and get ANSWERS not platitudes like “you just need some rest”.  Reasonable questions are things like:  “why do I need a CT scan”, “why am I in intensive care”, “why do I have a fever”, “what did you find during surgery”?
  • The doctors or physician assistants (PA) or nurse practitioners (NP) are in charge — the nurses are not.  If you have questions about medical or surgical issues insist on talking the doctor or PA or NP.  If you need an extra pillow or help getting to the bathroom talk to the nurse.  If you ask your nurse about the result of a test expect a vague answer “it’s just fine, get some rest.”  However, the nurses know what medications have been ordered and what is available “if needed or PRN”.  If you have a headache ask “what has the doctor ordered in case I have a headache”?  “nothing — well please call the doctor now since I have a headache”.
  • You need “your people with you”.  Family or friends should be present as much as possible and they should make contact with the health care providers both doctors and nurses — at very least each time they visit they should introduce themselves to the RN at the desk to see how things are going.
  • Who is available day and night?  It is a very reasonable request to know the name of the nurse in charge or the name of the doctor on call and to have them contacted if there is a problem.   If you are under the care of Hospitalists they are in the hospital 24/7 so it is very reasonable to request to talk to one of them at any time if needed — even on the phone, if that is adequate.  “They are busy” is sometimes true but not for hours at a time.  The nuclear option is to ask to speak to the “hospital administrator on call”  — a request that always gets their attention.
  • In any healthcare setting:  you are not out of line to point out that a doctor, nurse or therapist failed to wash hands or use hand sanitizer.  “Please wash your hands”. You do not want germs from other patients brought to you on caregiver hands.
  • Doctors will spend more time with you and answer more questions if they are comfortable — ask them to “have a seat”.  A room with no seats is unacceptable — that, you can tell your nurse.
  • Choose the right hospital in the first place.  Check the ratings of hospitals on the CMS website called “Hospital Compare”.  Driving a hour to a better hospital is absolutely worth your time and may save your life.  This is not like going to a fast food restaurant.  At this point in 2015 there is still a huge difference between hospitals — advertisements do not  mean a hospital is good.
  • Keep a written record — if you have a test write it down and leave a blank to fill in the result.  You really don’t need all the details — “you had a blood count and it was normal” is a fine answer.  If asked about your notes just say you have some difficulty keeping track of what is going on since you don’t feel the best — if you felt your best you would not be in the hospital!

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