Sunday, October 23, 2005

One for you, one for me

NewFNP loves to share. Lip gloss, fashion advice, tricks of the trade - all fair game. I draw the line at underwear, boyfriends and antibiotics. I'll tell you what - many of my patients share at least one of the latter three.

A patient last week came in with dysuria. She had discussed this problem with a friend who had once had similar symptoms and offered her the cure: a half-used tube of Metro-Gel. Only my patient had no clue cells; only nitrites, leukocytes and blood. Good luck treating that UTI with Metro-Gel, sister. I just have to ask: did her friend think to give her the applicator?

If Metro-Gel was the only shared medication, I would just shake my head, shudder and go on with my life. My patients, however, share the real goods. I'm not talking about percocet here. My patients are crazy for Doxy. Do they want diarrhea and yeast infections?

In Mexico, antibiotics are available over the counter. Great for when Montezuma strikes his E. coli revenge, bad for when you have a headache and decide to take 2 and call no one in the morning. Family member heading to TJ for the weekend? Pick up some doxy - one never knows when one might need it. When did doxycycline become the Mexican aspirin? Screw the 10-day course! It's a 'prn.'

OTC antibiotics are also scary when patients self-treat for an unknown condition. For instance, the patient who has daily forced sex (see Ayyyy me duele!!) has pelvic pain. What a fucking shock. Anyway, she has been treating her pain with Bactrim. For a year.

As clinicians, we are taught to use antibiotics judiciously and I am Scroogy McScrooge with my prescriptions. I am the asshole who will not give your 3-year old Amoxicillin for her ear infection. As I have learned in the past couple of months, however, focusing on clinician behaviors misses a huge component of the problem: people who self treat and inadvertently misuse antibiotics. Hi MRSA, hi C. diff.

This is a public health campaign waiting to be developed. You heard it here first. All we need are a bunch of fat, insulin resistant 12-year olds running around with MRSA, having unprotected anal sex and smoking cigarettes.

OK, probably not the cigarettes. Public health did a nice job on that one. Fight the power, public health. Fight the power.

No comments: