Doctors may too often do things that don’t work

About ten years ago I saw a doctor for a sinus infection and he prescribed antibiotics, even saying I wouldn’t get over it without them. That struck me as a bit implausible at the time. Did people really never recover from sinus infections a century ago? It turns out that serious studies suggest that antibiotics not only aren’t usually necessary to treat sinus infections that aren’t chronic, they’re very often a waste of money. And in general, of course, overuse of antibiotics promotes development of drug-resistant pathogens.

I should emphasize that this post is not medical advice specific to an individual condition. Listen to your actual doctor and not me on this. For one thing I’m not a physician, and for another there might be specific reasons why you should take an antibiotic for a sinus infection in many cases. For example, my infection had been with me for a while and an antibiotic might well have been appropriate, and in any event I followed my doctor’s instructions, filled that prescription, and took the full course of antibiotics. (I know enough not to stop taking antibiotics early just because I feel better. That leads to antibiotic-resistant bacteria.) Here I’m just reporting something said by people I think probably know what they’re talking about. It’s fine to ask your doctor whether you really need an antibiotic (there’s even a series of public health announcements on TV here in North Carolina to promote that), but don’t casually substitute your amateur judgment or mine for a doctor’s training. They might be wrong, but they have a better chance of being right than you or I do.

Several years ago the American Board of Internal Medicine’s ABIM Foundation launched an initiative called Choosing Wisely to provide doctors with evidence-based advice intended to discourage unneeded (and sometimes even harmful) interventions and diagnostic tests, something that sounds to me like a really good idea. For one thing, Americans may be spending hundreds of billions of dollars annually on tests, medications, and surgeries that aren’t actually helping them, and if so that’s a lot of waste. (Total medical waste in the U.S. may add up to well over a trillion dollars a year, as noted in the first video below.) Unfortunately, so far efforts to address this don’t seem to have had much influence.

Following are two videos on this subject (running about 10 minutes total) from pediatrician and author Dr Aaron Carroll:

On the program called Choosing Wisely as its advice to doctors:


On a study of changes in actual physician practice since the advice was widely promoted:


(If you’re not familiar with the term “NSAIDs,” it refers to non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen. More from WebMD here.)

Incidentally, to maintain my reputation as an insufferably annoying pedantic git, I’ll point out that Carroll apparently at least sometimes pronounces “processes” as “processeez,” probably unconsciously imitating the ending of plurals such as “crises” and “parentheses.” But the latter are plurals imported from Greek that involve changing the last syllable from -sis to -ses. “Processes” is a regular old English plural formed by adding -es to “process.”

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