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The Medical Professionalism Blog

It Was Just a Cough: Wasteful and Potentially Harmful Medicine

Over the past year I’ve written much about the Choosing Wisely® campaign, but a recent personal experience serves as the inspiration for this post.

Over his recent winter break, my 26-year-old son went skiing in Idaho. Fully insured on COBRA, he went to a free-standing urgent care facility in his small resort town for a cough. No culture was taken and he was never asked if he was taking any medications (which he is), but he did receive the following:

1)      A chest x-ray

2)      An asthma inhaler

3)      Antibiotics

4)      A prescription for a cough suppressant

Armed with knowledge about the Choosing Wisely campaign and the dangers of overuse from conversations with his dad, he stopped taking the cough suppressant and never used the inhaler (his cough was gone by the time he returned from his trip and he is fine now). He paid $100 out-of-pocket for all services – neither one of us know what the total itemized bill actually was.  Cost aside, what worries me is the potentially unnecessary harm to my son:

  • Taking antibiotics puts him at risk for antibiotic resistance as well as having an adverse impact on the general population from the overuse of antibiotics.
  • He was exposed unnecessarily to radiation, which may have large cumulative effects down the road.
  • He was prescribed a cough suppressant over an equally effective over-the-counter medication.

I asked him why he didn’t challenge the doctor regarding his treatment of what I presume was a viral infection. He replied, “Dad, how could I question the doctor? He is an authority figure with all of the knowledge. It’s hard for a patient to argue with their physician, particularly when they’re not feeling well.”

My son’s experience points to the challenge patients face of avoiding unnecessary care when presented with a physician’s recommendations. Do we place too much responsibility on patients to say no in the face of the expert?

The Choosing Wisely campaign aims to work with both patients and physicians regarding the recommendations of tests and procedures to avoid and have a joint informed conversation regarding what is best for the patient. In my son’s case, there was no such conversation. It is clear to me that our next step in the campaign is to get the recommendations from more than 30 specialty societies in the minds of all practicing clinicians and the Consumer Reports translations of these recommendations to all patients at the point of care so these types of conversations can occur.

Have you and your family have any experience with unnecessary care?  I look forward to hearing about your experiences.

2 Comments to It Was Just a Cough: Wasteful and Potentially Harmful Medicine

  • Randy Young's Gravatar Randy Young
    January 24, 2013 at 2:14 pm | Permalink

    Hi, Daniel -

    What a story … but all too common, I suspect.

    First, I’m glad your son is feeling better.

    Second, your tale raises several questions:

    First, “Why won’t the Emergency Medicine community participate in Choosing Wisely?” They offered several reasons in their explication, but one has to feel that a conversation with your son about the various diagnostic and therapeutic options would have led to better decision making as well as empowering him to question some of the interventions he received.

    Next is “how much responsibility can we expect a patient to shoulder in the decision-making process?” I think we have a long way to go before we can expect patients, even well-educated ones, to resist overuse of medical technologies. In fact, a lot of what happens in acute care settings like you describe is actually driven BY patients, who for example feel shortchanged if they leave without an antibiotic prescription.

    Again, I’m glad that your son did well … wish that were always the case.

    Thanks for the stimulating blog post!
    Randy Young

  • January 25, 2013 at 11:05 am | Permalink

    This paradigm is slow to change–but a recent study published in Arch Int Med suggests that simple strategies–including patient education–can reduce, though not eliminate, inappropriate antibiotic use; see http://archinte.jamanetwork.com/article.aspx?articleid=1556795#qundefined

    But yes: it is asking a lot of patients to expect them to be responsible for ensuring they’re receiving evidence-based care. Empowering them with the facts, as CW and your partners at Consumer Reports are doing, will help many more of us ask questions and start the conversations.
    Diana

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