Where did you get your license, KMart

**canoehead, BSN, RN** · Dec 6, 2009

I think she was right, but she could have given you something for symptom relief.

Thankful RN,BSN · Dec 6, 2009

how come you couldn't get the meds or scripts from your place of employment?

silas2642 · Dec 6, 2009

I think she was right, but she could have given you something for symptom relief.

How could you possibly know if you haven't seen the patient?

morte, LPN, LVN · Dec 6, 2009

she may well have been correct....and she did suggest OTC for symptom relief.....

Jolie, BSN · Dec 6, 2009

Sorry, but I don't agree. I think it is a shame that you are belittling this person's education and credentials because you don't agree with her clinical judgement. It sounds like she is trying to avoid unnecessary prescribing of antibiotics in favor of inexpensive and safe home measures such as nasal washes and OTC meds for comfort. What's wrong with that?

If the PA you work with is so certain that antibiotics are indicated, why did he not prescribe them?

Trauma Columnist · Dec 6, 2009

it would be impossible for us to say if this was correct treatment or not. hope you feel better soon.

**canoehead, BSN, RN** · Dec 6, 2009

How could you possibly know if you haven't seen the patient?

I don't have the education to make a diagnosis either, but she asked for an opinion, and that's the one I came up with.

Dr. Tammy, FNP/GNP-C · Dec 6, 2009

I've had my share of angry patients where I've not Rx'd antibiotics. This anger is a multifactoral phenomenon.

First, patients are conditioned over a life time to receive antibiotics whenever they are sick, even when the prescriber knows, or ought to to know, the condition is viral in origin. Prescribing antibiotics for viral URI's and bronchitis not only does not fit with current literature, it places the entire community at risk regarding isolating and proliferating super bugs. I guarantee, within our lifetime we will see a better than 50% resistance to azithromycin and levofloxacin largely based on the inappropriate prescribing of antibiotics.

Second, it's much easier for the patient flow to just give an antibiotic RX and be done with the patient encounter. The time it takes to educate patients on the dangers of inappropriately prescribing antibiotics could double the amount of time versus just writing a script.

Third, because of previous conditioning, patients often think they know whats better--based on experience. The loss of objectivity on the part of patients is so commonplace, that some often will not hear why it is dangerous to recieve antibiotics.

Clearly, in this case, it is unclear whether or not the poster needed antibiotics. This decission is based on a comprehensive HPI & physical assessment. I will say, though, as stated above, I have spent countless encounters explaining to patients the rationalle as to why I am not prescribing antibiotics for URI's and bronchitis when after the fact, they go to another NP and say something like, "The NP refused to give me antibiotics and didn't give any reason why."

Dr. Tammy, FNP/GNP-C · Dec 6, 2009

Almost forgot. A good way to turn a simple viral bronchitis into pneumonia is to take cough suppressants. With your asthma history, I would especially encourage you to obtain another opinion before taking any antitussive, even benzonatate.

zenman · Dec 7, 2009

I'm with Tammy. Physicians have overused (incorrectly) antibiotics for years and they didn't get their license from K-Mart!

prairienp · Dec 7, 2009

:angryfire ok. i'm a lpn working on my bsn. i've been sick for little over a month with a cold. this past week i have been progressively worse. i work in a doctor's office and the pa said i need to get a script for a z-pack. this morning i went to one of those quick care places in the drug store. there was a fnp on duty. i told her my symptoms: headache, non productive cough, achy, runny and stuffy nose, low grade fever, and chest congestion. without even seeing me she said take some otc meds. i told her i needed antibiotics. she said who told you that. i told her a pa that i work with. she proceeded to tell me that i was not sick and that if the pa wants me to have meds then he could give them to me. but i can see you if you want, but i'm not giving you anything for it. i said ok thanks and walked out. i was never so outraged as i was today. it was just a disgrace to our profession. for a split second i thougt i don't want to become a np anymore if i have to work with np's like her. she just totally disregarded me. i ended up going to another clinic and saw a md who gave me a z-pack, tessalan pills and advair( i have asthma) without me having to tell him what i needed. what are your thoughts about this?

several points. if you have asthma why did the md add advair, if you had symptoms why didn't you receive a neb. tx in the office? if you have asthma and have been sick for over a month, and in past week worse, why all of a sudden going to urgent care? if you had been sick for 3-4 weeks and have asthma, and now worse wouldn't you go in right away or call your pcp or pulmonary provider? what did the md find that resulted in antibiotics being given? you honestly never told the md what you needed? yet, you didn't hesitate to tell the np you needed antibiotics? i suspect there is a lot more to the story. based on what i have read, the np should have seen you to evaluate your condition. the pa was wrong, the np was wrong and the md may have been wrong.