The Rolling Stones said it best: “You can’t always get what you want.”
Patients often ask why they didn’t get ________ during an office visit. They say, “I needed an antibiotic.” or “I’ve always gotten this lab work before.” “Why can’t I get what I want?”
The answer is both simple and complicated.
The simple answer is: Changes in medical science can change how your health care provider treats you.
The science behind those changes is a bit more complicated. Take hormone replacement therapy (HRT), for example. After many years of HRT prescribing, research began to show that heart disease and breast cancer risk increased with long-term HRT use. So, while HRT provided many benefits to menopausal women, the risks generally outweighed the benefits. This prompted providers to change their approach.
Here are three more examples of practices that have changed: antibiotics, pain medicine and lab work.
Picture this: You have a stuffy, drippy nose. You feel run down, have body aches and a low-grade fever. When you blow your nose, you see lots of green or yellow discharge. This has been going on for 2-3 days. You need an antibiotic, right?
Not so fast. What you have is likely a virus. Symptoms that exceed 7-10 days may mean a bacterial infection, but fewer days is usually a virus. And antibiotics do not treat viral infections. They also won’t prevent a viral infection from turning into a bacterial infection. Additionally, green or yellow nasal discharge does not necessarily mean it’s time for an antibiotic.
Some people will say, “But they helped me!” Chances are if you took an antibiotic when you had a viral infection, it wasn’t the drug that helped. Rather, the virus simply resolved on its own, as most do in 5-7 days.
There is a growing danger in taking an antibiotic when you don’t have a true bacterial infection: antibiotic resistance.* This occurs when antibiotics are used improperly. Bacteria in your body (or in the community) can change and become resistant to the antibiotic that should treat them. So when you have a real need for an antibiotic, it may not work.
Do you really need an antibiotic?
You’ve likely heard about the opioid epidemic plaguing our nation. What you may not realize is opioid addiction is happening to well-meaning people with a real need for help with pain. Because opioids are so addictive, even taking them exactly as prescribed can lead to problems for some people. That’s why providers are now prescribing them with much more caution — and why states have put more restrictive guidelines and laws in place.
When used correctly, opioids can play an important role in managing acute pain, such as pain after surgery. This type of pain is generally temporary and improves after healing.
For chronic or long-term pain, providers are opting for non-medication options, such as physical therapy, and safer, non-opioid alternatives, such as NSAIDS (non-steroidal anti-inflammatory drugs). NSAIDS are available in prescription and non-prescription strengths. Commonly prescribed NSAIDs include ketorolac (Toradol®), celecoxib (Celebrex®), diclofenac (Voltaren®) and meloxicam (Mobic®).
Over-the-counter (OTC) NSAIDs and pain relievers, such as acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), can be good alternatives to prescription NSAIDs. However, it’s important to remember that both NSAIDs and acetaminophen carry their own risks, so you should discuss your options with your provider.
You may have noticed that your doctor is not ordering as many lab tests as she once did — or that you’re footing the bill for labs that are ordered. There is a reason for that, and it’s the same one we mentioned above: Guidelines are changing based on research.
Newer studies show that many lab tests, such as blood count (CBC), thyroid (TSH) and vitamin D and B screenings, are not medically necessary unless you have specific symptoms. So ordering these tests when you don’t have symptoms does not help you. In fact, many insurance companies will no longer pay for these tests. Ordering tests outside recommended guidelines increases costs for everyone.
Let’s wrap it up
So why will some providers order these treatments but others won’t? The simple answer is: There are so many changes in medical practice that providers can’t always adapt as fast as new research comes out. Most providers try to implement new evidence-based practices, but it takes time. And some providers adapt faster than others.
So don’t forget the Stones’ next line in the song: “But if you try sometimes, you might find you get what you need.”
If you’re used to getting an antibiotic after just a few days of symptoms, then you go to a clinic and don’t get one, remember this: the provider isn’t trying to deny you services you need. It’s actually the opposite. Providers are working to provide the most appropriate medical care that helps you get better without inadvertently causing more problems down the road.
If you have questions, give us a call at the ParTNers Center at 615-741-1709. We always strive to provide safe, quality care that follows the most up-to-date medical guidelines.