Antibiotics have been overprescribed — doled out to patients who don’t need them — for years, despite efforts to curb the problem. In outpatient settings, like doctors’ offices, research finds at least one-third of antibiotics are prescribed unnecessarily.
Far from being a safe “just in case” practice, the habit can harm patients: the drugs can cause rashes, diarrhea, allergic reactions and serious Clostridium difficile infections that lead to hospitalizations, among other superbugs that are harder to treat with drugs.
Efforts to reduce antibiotic prescribing have largely focused on doctor and patient education regarding when the drugs are appropriate. But as the high level of unnecessary antibiotic prescribing persists, there’s another strategy that’s gotten far less attention: Having patients avoid seeing a doctor in instances where unwarranted antibiotic use are common. Namely, avoiding going in for a visit to treat the common cold or sinusitis and bronchitis; illnesses that drugs can’t help yet for which antibiotics are unnecessarily prescribed about half the time, says Dr. Ateev Mehrotra, associate professor of medicine and health care policy at the Harvard Medical School in Boston, and a policy analyst at RAND Corp., a nonprofit research organization. “Office visits for colds, sinusitis or acute bronchitis should be viewed as wasteful, error-prone events; patients are spending valuable time going to the doctor and putting themselves at risk for exposure to a potentially harmful chemical,” Mehrotra wrote in a commentary published in the journal JAMA Internal Medicine in September.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
When it comes to balancing benefits and harms, primary focus is understandably placed on preventing people from unnecessarily going to the emergency room, where intensive, involved testing and care is the norm. But experts say at any place a patient might seek medical care — including a relatively low-risk setting like the doctor’s office — there’s reason to take a balanced approach to prevent harm from taking unnecessary medications or undergoing unneeded tests and treatment. “We have this kind of quandary, which is on the one hand we have underutilization [of health care], on the other hand we have overutilization,” Mehrotra says. Notably, many patients with chronic conditions benefit from seeing their doctor regularly to manage their conditions, says Dr. John Meigs, Jr., president of the American Academy of Family Physicians. And while some patients seek medical care for minor illnesses when they could safely stay at home, others don’t see the doctor as recommended to manage conditions ranging from diabetes to high blood pressure.
In the absence of broadly accepted guidelines for when patients should see a doctor and how frequently, experts say there are still some ways patients can strive to strike a healthy balance.
Don’t seek a cure for the common cold. “There is no treatment for that,” Meigs reminds, noting many patients still want antibiotics to treat a cold. “If you’ve got sniffles, congestion, a little scratchy throat, give it a few days. [It] may clear up all by itself.” Colds frequently last a few days to a week and sometimes persist for a couple weeks. Strategies like staying hydrated and over-the-counter medicines may help address symptoms. But when symptoms persist beyond a week, particularly if other concerns arise — including fever, chest pain, being short of breath or coughing blood — he advises seeking medical attention.
[See: Who’s Who at Your Doctor’s Office.]
Evaluate the annual exam. A historic pillar of the patient-doctor relationship, the annual exam or physical has come under fire due to a lack of evidence that symptom-free patients benefit from this standardized exam. As early as 1979, the Canadian Task Force on the Periodic Health Examination suggested the practice be abandoned; and in 2013 — as part of the Choosing Wisely initiative that promotes conversation between patients and providers about unnecessary care — the Society of General Internal Medicine recommended against annual preventive exams for asymptomatic patients, notes Mehrotra, in a perspective piece arguing against the annual exam in The New England Journal of Medicine published last October that highlighted the decades-long debate.
Most patients already see their doctors more than once a year, making the physical unnecessary to maintain the doctor-patient relationship. “If you’re really healthy and your physician agrees with you, maybe you don’t need to see [your doctor] but every couple of years,” Meigs adds. But he says that should be a mutual decision made by patient and doctor. He warns against the dangers of being out-of-touch with one’s health provider. In addition to emphasizing the importance of eating well, exercising and keeping weight in check, he notes that if a person goes several years without seeing a doctor, sometimes vitals creep up unnoticed — from blood pressure and blood sugar to cholesterol levels. For patients with chronic conditions or other ongoing health concerns, it may makes sense to see a physician more often than once a year, he adds.
Be circumspect about online symptom checkers. Now widely used — roughly 100 million times worldwide annually — symptom checkers are typically accessible through websites and sometimes through mobile apps and provided by organizations ranging from WebMD to the American Academy of Family Physicians to Harvard Health Publications, letting patients plug in how and what they’re feeling. In response, these symptom checkers often compile a list of potential diagnoses and advise on whether to seek care — helping patients self-triage or determine if they need to see a doctor. “I think the idea and theory are really awesome, and it really could help,” Mehrotra says. However, research he was involved in that evaluated symptom checkers, published last year in the journal BMJ, found both deficits in diagnosis and triage advice — including that symptoms checkers routinely encouraged users to seek care for conditions where self-care is reasonable, the researchers noted. Adds Mehrotra: “A lot of times the symptom checker would say to you, even though it was bronchitis and you probably didn’t need to get care … you should probably go get care,” he says. “These tools may be useful [for] patients who are trying to decide whether they should get to a doctor quickly, but users should be cautious and not take the information they receive from online symptom checkers as gospel. “So though not discounting their potential usefulness outright, experts say symptom checkers could lead some browsers to see the doctor unnecessarily.
In a disclaimer, the American Academy of Family Physicians says its symptom checkers aren’t a substitute for medical advice and shouldn’t be relied upon to make decisions about one’s health. It adds: “Always consult your family doctor with questions about your individual condition(s) and/or circumstances.”
[See: 5 Common Preventable Medical Errors.]
Call ahead. Taking the initiative and having some autonomy in determining when you need to seek medical care doesn’t mean going it alone. Increasingly health organizations are making it easier for patients to reach health professionals to get questions answered before they step foot in a medical office, says Hayden Bosworth, professor of medicine at Duke University in Durham, North Carolina. That goes from email to online communication with doctors to receiving advice for managing a chronic disease through a nurse call line or having a quick phone conversation to determine if it’s worth scheduling a doctor’s visit to treat a minor ailment. “Make a call and find out is this something where I need to come in [for a] visit,” Bosworth says. That simple step could save time and money — and even reduce your exposure to health care-related risks.
“Everybody needs health care. But … not too much — mostly primary care,” Meigs says. “Don’t overdo it.” And, he adds, don’t ignore the need to seek care either.
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