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A patient called me on the phone while I was on call recently demanding a “Z-pak.”  A Z-pak, as many of you may know, is a popular prepackaged course of antibiotics commonly used for respiratory infections.

“Hello Ma’am, I’m Dr. Odom, what can I do for you?”  I asked.

“I need a Z-pak.”  Remarkably, this was her chief complaint.

“And what makes you think so?” I said.

“Well, I woke up this morning with a scratchy throat and runny nose.  Everyone in my office has been sick and they’ve called their doctor’s office and are taking Z-paks of antibiotics.  I don’t have time to be sick, so I need you to call in a Z-pak for me.”

After a few more questions to make sure she didn’t have any other symptoms or underlying conditions that would raise my concern level, I told her that her symptoms sounded viral and I didn’t think antibiotics of any kind would do her any good, but that she was welcome to come to the office the next day for further evaluation in person, or to go to a nearby walk-in clinic with weekend office hours.

Unfortunately, she then became quite agitated.  As I tried to explain my decision to her calmly and rationally, she interrupted with a few rude comments questioning my medical knowledge, then hung up on me.

A few useful points you can take away from this exchange:

Don’t expect your doctor to treat you over the phone.  Though most doctors do it from time to time, none like treating you over the phone.  It’s not in your best interest, and it’s just not good medicine.  There’s no substitute for talking to you in person and examining you.  If you believe you have a serious enough problem that you may require further testing or drug treatment, you owe it to yourself to take the time out of your schedule and see your doctor for a real evaluation. 

Don’t go to the doctor for a respiratory illness hoping to get a prescription for antibiotics.  Most patients have the truly mistaken mindset that when they start to develop respiratory symptoms, they should get a prescription for antibiotics in order to “head off” the infection or to get better faster.  The truth is, the vast majority of respiratory infections, somewhere in the neighborhood of 90% or more, are viral, and don’t respond to antibiotics like bacterial infections.  A lot of physicians feel pressure to prescribe antibiotics for patients seeing them for respiratory illnesses, even if they believe it’s likely viral, because they’re worried patients may feel “cheated” or that they wasted their time by coming in if they don’t leave with a script for a “Z-pak” or something similar.

Antibiotics are powerful drugs that should be reserved for when you really need them.  Overuse of antibiotics leads to drug-resistant bacteria, such that when they do cause an infection, it can be very difficult to treat.  Antibiotics also have the potential for side effects, from rashes to diarrhea to yeast infections.  There’s no need to expose yourself to those risks if you don’t need to.

So do me a favor, the next time you go to the doctor for a respiratory infection, go with the mindset that you’re hoping you won’t need antibiotics.  Actually say to your doctor, “I’m feeling sick, but I hope you’ll tell me I don’t need an antibiotic.”  Believe me, that’ll put your doctor at ease, but you can bet if you do need an antibiotic they’ll still prescribe one for you.  They’ll just be less likely to give you a script just to keep you happy.

Don’t delay a doctor’s visit if you have chronic lung disease like asthma or emphysema, or have conditions or medications that suppress your immune system such as lymphoma, AIDS, chemotherapy, prior organ transplant, etc.  In the setting of those conditions you can become very ill very quickly and are much more likely to need antibiotics.

Consider prevention.  The best treatment for respiratory infections is to prevent them in the first place.  Discuss with your doctor whether you would benefit from a yearly flu shot or the pneumonia vaccine (I’ll get around to discussing vaccines in more detail at some point).  Wash your hands a lot, and avoid close contact with large groups of people or those exhibiting symptoms obviously.

So the next time your doctor tells you that you don’t need antibiotics, instead of being angry or disappointed, be thankful.