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Comment by dzdt | Hacker News Reader

There is a systematic property of the modern medical system to overtreat.

At the first level, if a patient goes to a doctor the expectation is the doctor should do something to help. If the doctor says, "sorry there is nothing I can do" the patient will likely leave unhappy and try a different doctor. This leads to things like prescription of antibiotics for viral infections. There is no effective treatment, but patients leave happier with a useless treatment than with a denial.

One thing ignored in the article is that, in this role as a placebo prescription, a longer course of antibiotics outperforms a short course. That is because a longer course gives a viral infection a longer time to clear up on its own.

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Of course what should happen is that if a patient with a viral infection goes to 1,000 doctors, they should be denied antibiotics 1,000 times.

I'd be more accepting of that if they actually tested before saying "there's nothing we can do".

I had a seven week bout with bronchitis recently because the first three doctors I went to insisted "it's viral, there's nothing we can do" without doing a sputum test. When I finally found someone who would give me a Z-pak it cleared up in three days after weeks of misery.

It's also a problem when the system has swung so far the other direction that you can't get medication you actually need.

Unless you got a positive bacterial cultural you still don't know if it was the z Pak that cleared up your bronchitis or your immune system. The vast majority of illnesses are self limiting and bronchitis is one of those things that can really linger, every time I get it it takes more than a month to clear up (on its own).

Doctor could give a note that results in sick days. That's something they can always do.

I understand that is the expectation for some, but I personally am happy when the doctor tells me I'll be better on my own. It keeps me form worrying that I have something more serious.

Secondary infection is a thing. Antibiotics may be prescribed to reduce the risk of that.

In most cases a secondary infection is going to be more of an annoyance than a danger, so for otherwise healthy people it probably makes sense to treat a secondary infection when it appears.

I heard that even from a veterinarian who prescribed antibiotic to my cat with acute viral infection, in a course of complex treatment. Now I wonder was antibiotic really necessary.

And as anyone with a child recently placed into daycare in a major city will tell you, what happens is the kid gets the sniffles from a cold virus/whatever, and it turns into a sore throat, then a bacterial sinus infection, then a ear infection, and at this point the bacterial infections at the daycare are resistant to antibiotics, so they end up gradually rolling down the sickness hill until the doctor prescribes something strong enough to knock it out.

And god forbid, mom/dad get it. I almost died from some crap my daughter brought home because the doctor sent me home twice with a "suck it up" attitude (after I had been "sucking it up" for nearly two months), until I ended up in the emergency room at 1AM with pneumonia, a massively elevated temp, and a pleural effusion that was so painful I could barely breath. The doctor that sent me home called a couple days later (because they took blood samples and some swabs) with a "we have to see you now" call, at which point I was like, yah thanks a lot for nothing...

AFAIK, antibiotics are usually only prescribed prophylactically to sensitive populations or for apparent viral infections with a particularly elevated risk (with frequency or severity) from secondary infection.

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