Demand Antibiotics? Who, Me?
Clinicians don't necessarily agree on the true causes of antibiotic overprescribing, or how to solve the "national obsession with antibiotics." Still, many shared concerns are apparent from the reactions of Medscape readers to the findings of the reader survey on antibiotic prescribing, starting with "Frankly, I don't believe it."
For many clinicians, what patients claim about requesting (or "demanding") antibiotics vividly contrasts with their experiences caring for patients in emergency departments (EDs), urgent care centers, and outpatient settings. The source of disbelief is the consumer response to this question: "Have you ever asked a healthcare provider to prescribe antibiotics even though you were not certain that antibiotics were needed?" An unexpected 77% of consumer respondents said "no," meaning that only 23% of respondents admit to ever asking for antibiotics for themselves or a family member. Is the patient demand for antibiotics merely a convenient fiction?
Many clinicians find the claim that "77% of patients don't ask for antibiotics" hard to swallow, as reflected by this comment: "As both a primary care and infectious diseases physician, the patient answers [to the survey] and my experience don't agree. Most people who come in are asking for antibiotics. I don't prescribe them when not necessary, but most of the time, there is disagreement." A physician assistant likewise doesn't believe that the survey results match what is seen every day in the office. "I often have patients, sometimes multiple times each day, get quite upset when an antibiotic prescription is denied to them. Even after explaining my rationale, some [patients] argue with me or head straight over to an urgent care center and obtain their antibiotics there instead."
One physician blames patients who flood urgent care centers seeking care for run-of-the-mill ailments such as "simple ankle sprains, sore throats or diarrhea for one day, sunburns -- the list goes on. None of us would even consider seeing a doctor for such common and trivial matters. I see about 50 patients a day, and easily 75% of them have no business seeing a physician. And 80% of those patients are expecting antibiotics."