I just read another interview with a CDC doc who doesn't actually treat patients, and complains that 50% of antibiotic prescriptions are un-necessary. I am sure he is right about most of them.
What he didn't say anywhere, is that the decision not to do anything is going to result in several patients this time of year being admitted with pneumonia a few days after you see them in clinic, and tell them that acute viral bronchitis does not need antibiotics. He also didn't address that coming back to see the doctor yet again costs real people real money, and oh, by the way, we are in a RECESSION right now. Missing even more work for working patients, if they do have pneumonia that wasn't treated, will cost them even more.
Our patients expect us to be right every single time, unless we are House (the TV doc). HMOs expect us to get people in, treat as little as possible while preventing everything expensive, and bill maximally. We know that is not realistic. So simplistic "just don't prescribe" sermons by dolts who rarely treat real people just come across as wildly unrealistic. Contingency-prescribing ("fill this if no better or worse in X days") would be a more realistic approach than the black and white recommendations of the experts from their statistics labs.
In the meantime, I am sure that I will hear more experts complain about primary care over-prescribing antibiotics, and hospitalists complain about why we didn't. It's easy to call the plays from the nice clean announcer's box when you don't have the defensive line breathing down your neck!
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