Z-Pack Pas de Deux

I’m really miserable and need that 5 day antibiotic to get better faster.

Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and decongestant nose spray.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face.

And I’m feverish and having sweats at night.

Your temp is 99.2. You can use ibuprofen or acetominophen.

But my snot is green.

That’s not unusual with viral upper respiratory infections.

And my teeth are starting to hurt and my ears are popping.

Let me know if that is not resolving in a week or so.

But I’m starting to cough.

Your lungs are clear so breathe steam, push fluids and prop up with an extra pillow.

But sometimes I cough to the point of gagging.

You can consider using this strong cough suppressant prescription.

But I always end up needing antibiotics.

There’s plenty of evidence they can do more harm than good.  They really aren’t indicated at this point in your illness.

But I always get better faster with antibiotics.

Studies show that two weeks later there is no difference in symptoms between those treated with antibiotics and those who did self-care only.

But I have a really hard week coming up and I won’t be able to rest.

This may be your body’s way of saying that you need to evaluate your priorities.

But I just waited an hour to see you.

I really am sorry about the wait; there are a lot of sick people with this viral thing going around.

But I paid $20 co-pay today for this visit.

We’re appreciative of you paying promptly on the day of service.

But I can go down the street to the walk in clinic and for $95 they will write me an antibiotic prescription without making me feel guilty for asking.

I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I think you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.

So that’s it?  Salt water rinses and wait it out?  That’s all you can offer?

Let me know if your symptoms are unresolved in the next week or so.

So you spent all that time in school just to tell people they don’t need medicine?

I believe I help people heal themselves and educate them about when they do need medicine. 

I’m going to go find a real doctor.

A real doctor will first do no harm.  I wish you the best.

6 thoughts on “Z-Pack Pas de Deux

  1. Emily
    I love this posting…I am going to frame it I think! Such wisdom!! You are a good, caring, educated Physician whom I am proud to work with.


  2. Just found your blog- I’m appreciative of what and how your write!

    Way back in the 70s, my university health service had a walk-in self care clinic for URIs. (Pre computer, natch) Students followed a symptom/treatment algorithm in a loose leaf binder format, which ended up with a prescription for OTCs and self care such as ibuprofen, cough suppressants, Vicks vapo rub, humidifiers (which could be borrowed from the clinic) or with the direction to sign into the clinic in the case of s/s of bacterial infections or uncontrolled dehydration.

    It was very well received. Wonder if your office could do an online pre-appt version. It would kill several birds: increase patient education, cost savings, time savings (for both you and patients) and increase patient satisfaction. You could do all sorts of fancy stuff with the algorithms, such as providing links to reputable patient education sites, links to patient self management and health tools, provide a self-monitoring diary tool for symptom reporting, and even provide a tool for reporting treatment effects and symptom resolution.

    I think that physician office online patient tools could be used in so many ways: providing screening tools for things such as depression, sleep disorders, medication use, supplement use, blood glucose monitoring, VS monitoring, etc., etc.


  3. Hi AEK,

    yes, definitely doing all of the above, including online screening, self assessments and symptoms history prior to visits. The options are endless!



  4. Oh, I so wish there were more HCPs with this attitude. My own mother-in-law (a retired RN) thinks one needs to throw antibiotics at every sniffle. She has great intentions, but somehow nursing school has failed her with regard to the consequences of doing so – and the samples left at her boss’ office were often inappropriately dispensed to family members.


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