A weird part of this job is giving people medications that are more likely to hurt than help them.
I regularly give medications that I wouldn't let my own family take for the same condition- and neither would the doc. Most commonly this involves antibiotics for likely viruses, which is usually not all that harmful. They do increase antibiotic resistance, causing people to be more likely to get sick. Frequent minor side effects like nausea. I have seen a few major incidents like anaphylaxis and tendon rupture for abx prescribed with pretty weak rationale. I am sure that if I could track every er pt I have ever seen, I could find a death directly linked to an un-needed abx, but not all that common.
Then, of course there are medications that assist people in hurting themselves- GERD med for people who's reflux is worse when they eat terrible food, for example. I have medicated people who's chief complaint is that their breathing is so bad they can't even smoke.
There are lots of examples, but recently gave somebody meds, actually, a prescription) for medication, likely to kill him.
Pt had a hx including alcoholism and polysubstance abuse. He came in with right sided abd pain after eating a large, greasy meal. Unsuprisingly, the problem was his gall bladder. Surprisingly, his pain was helped by toradol. No reason to think this problem would reccur as long as the pt made reasonable diet choices. And, the guy was pretty reasonable.
I sent him home with gall bladder instructions and a prescription for Vicodin. We know for a fact that this drug has a huge potential for an adverse effect needing hospitalization. We have hospitalized this patient for an adverse effect relating to this drug category.
The potential benefit of this drug was trivial: The pain could easily be avoided, and was well managed by the equivalent of ibuprofen 800 mg po.
The risk was lengthy hospitilization, or potentially death.
There is no other drug we would give with this risk/benefit ratio.
It's very frustrating. More so than usual with this guy- a nice enough guy, not even lobbying for narcs.
