Reducing Worthless Medical Visits

An increasing number of medical visits are for, literally, nothing. People are paying good money for self-limiting illnesses, like a "one day history of a runny nose," or "had abdominal pain last week," or my favorite, "going out of town - would like to know if he is getting an ear infection." True, people are paying for my time...my medical skills...my opinion, but I really hate charging people over and over for the same advice. A visit is often longer when someone doesn't have an ear infection, than for one that does. I have to exhaustively explain why a child may be pulling on their ears when they don't have an ear infection.

It is a fact that many people do not have the self-care skills or confidence to make simple health decisions. Many young parents, especially the well-insured, are afraid or unwilling to make medical decisions for themselves or their families. Their dependence on the health care system can be overburdening. I bet that your mother or grandmother didn't rush you to see the doctor with a sniffle.

People can, and should, take more responsibility for their own health care. While I realize that part of my responsibility to help patients make responsible decisions, some people keep coming in, over and over, for minor illnesses. Every medical visit must have an educational component, otherwise the cycle of worthless visits will continue. When the out-of-pocket expense may be only five to ten dollars for their insurance co-pay, many people relinquish all health decisions to the health care provider. In the old, fee-for-service days where people had to pay cash for each visit, there was a bit more home, decision-making going on.

An example would be the Common Cold. Colds last a week if you aggressively treat them; seven days if you leave them alone. Colds are worse for the first 3-4 days; then they gradually get better. Unless there is a strong suspicion that a secondary bacterial infection (high fever, chest pain, persistent earache, increasing sore throat, etc.) has developed, there is really nothing the medical establishment can really do to shorten the course of a self-limiting, viral infection. We can prescribe decongestants if you are stuffy, antihistamines if the mucous is dripping down your face, cough expectorants if your chest is tight, or a cough suppressant if it is interfering with your sleep or daily life. We can recommend acetaminophen or ibuprofen for the aches and pains, or the discomfort associated with fever. We cannot cure colds, but we can alleviate people's anxiety that the cold is "just a cold."

For some people, this is worth the medical visit. For others, they leave feeling cheated that I didn't give them an antibiotic. For the people that were refused antibiotics, most will get better and a few will not get better as fast as they wanted. They will go somewhere else, attribute the persistence of their illness to my refusal to give them amoxicillin, and some gutless, medical wonder will give them an antibiotic. A few days later, they get better, thanks to the last medical provider that saw them. Of course, none of them realize that they would have gotten better anyway.

I get the magazine, Budget Traveler. Each issue has a list of suggestions made by readers to make traveling easier. One of those suggestions this month said "Ask your doctor for an antibiotic prescription before you leave on a trip, just in case you get sick." Antibiotics are not miracle cures for all that ails you. As a matter of fact, the use of antibiotics in a viral illness is counter-productive and is very poor medicine. Getting ill on vacation happens. Why? First, your biological clock may be stressed. Second, you may be in an area where you have little immunity to local germs, or flew on an airplane more contaminated than a dumpster. And, third, you get sick because you are worried and expecting to get sick. Antibiotics will not change these facts, nor will they protect you once you arrive at your destination.

It is not easy, but people need to trust their immune systems more than they do. Illnesses happen, so why be surprised? Spend a little time educating yourself about common health issues, like colds, sore throat, earaches, diarrhea, and headaches. The vast majority do NOT turn into pneumonia, strep, ear infections, dysentery, or brain tumors. In most cases, it is okay to allow your body time to heal. And, it is okay to treat misery. It is not okay to rush to your doctor's office two hours after waking up with a sore throat, or when your two year old pulls on his ear. Watch. Wait. Save your money. Save your time.

For each illness that you overcome without the intervention of the medical establishment, the more experience and confidence you will achieve. Yes, you will second-guess yourself. Yes, you will still make an occasional "worthless visit." But, in the end, you will gain the knowledge and skills needed to take care of some of these minor, medical annoyances at home - safer, faster, and often, better than if you sought professional care.

Related Topics:

• WebMD Video: Kids and Cold Medicines
• WebMD Video: Surviving Kids' Cold Germs

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