Today I was confronted with the great antibiotic demand. First, from a patient that I was discharging to home. Mom and Grandmother had brought in this first born son at about 6 weeks of age for vomiting and poor suck. He was a skinny little thing who had not yet regained his birth weight (this should have happened within 2 weeks of birth). An abdominal ultrasound revealed a pyloric stenosis (a narrowing of the stomach outlet where it joins the small intestine, leading to forceful vomiting) and baby was sent off for surgery after we had rehydrated him. In the US, we would have checked his electrolyte levels, but that test was "OS" or out of stock, so we just rehydrated and sent the baby for surgery when he "looked" better. He spent 2 days on the surgical ward, and then was sent back to us. Today, he had finally regained his birthweight (in fact was making good weight gain progress every day through breast feeding alone) and Mom was begging to go home. I agreed in the morning, wrote the discharge summary and said my goodbyes. When I came back for afternoon rounds, mom was still there. She had waited to see me, she said, because "I think that this baby needs some syrup." What for, I asked? We hadn't treated the baby with anything other than the initial fluids and then surgery. There were never any antibiotics (syrup) given. "To make him into a strong boy," she said. We talked about healthy eating, vaccinations and general well child care. "Yes, yes. I will do that. But the syrup?" It took another 10 minutes before she finally accepted that no antibiotics were necessary.
In the clinic I saw two little kids, each with viral upper respiratory infections. The doctor they had seen earlier in the day did a much more thorough work up than I would have done, and for each child everything was negative. The parents of each patient wanted medicine. I offered to write for paracetamol (tylenol), but no one was impressed with that. I explained about viruses, and how antibiotics don't help. I talked about the time course of illness and supportive care. I got blank stares in return or questioning looks. When I left clinic later on, one of the mother's was sitting waiting on the bench. She wanted to see another doctor, one who might give antibiotics. I explained that there was no other doctor until the night clinic opened in a couple of hours. She said she would wait.
This is certainly not a problem specific to Cameroon. It is a discussion I have nearly every day in the US, and one that I never seem to get better at. I have tried different tacts - antibiotics have side effects, too! You will get better in 7-14 days whether you take antibiotics or not! disease resistant to antibiotics is coming! Nothing seems to work. If a patient has decided that they need antibiotics, then they are unlikely to be happy or comforted by whatever explanation I give. I just keep hoping that someday I will get through to someone!
1 comment:
I think you're right about people wanting their antibiotics. I have found that most places I have lived I run into this reflex to run to antibiotics for various ailments that don't necessarily require them. El Salvador... and the U.S. Actually, back in the day, our family pediatrician used to put me on antibiotics as a prophylactic measure whenever I got any kind of respiratory thing. And even nowadays I have heard, more than once, people who work in healthcare talking about getting a Z-Pak for themselves when they get a nasty cough (without having diagnosed any bacterial component to the cough). So, I'd say that this is indeed a pretty prevalent thing still. Bravo for insistent medical practitioners who repetitively educate the public and our own healthcare community about the differences between viral and bacterial infections and the proper administration of antibiotics!
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