Back in 2003, as a coach of a girls youth soccer team, I
used to take the kids to a hamburger stand after each game. The owner always greeted me warmly. “Hey doc, how many burgers today?”
“Ten,” I said one day.
The owner looked distressed. “Hmm.
I might not have that many.”
“I have 10 hungry kids,” I interjected. “They’ll be disappointed if they don’t each
get a burger. This was our last game,
you know.”
“I’ll check again,” he replied. Soon he returned with 10 burgers. “Got lucky.
Sorry about the scare.”
“No problem.
That’s why I come here. I always
get what I want.”
The next day a player’s mom called to say her daughter
had diarrhea and was vomiting. “Could it
be food poisoning?” she asked.
I told her I would find out.
I called the hamburger stand owner and told him that one
of the kids was sick, and asked if the burgers could be responsible. To my surprise, he said “Yes.”
“Remember, I didn’t think I had enough burgers, then came
back with 10?” he said, without a hint of distress. “Well, I only had 9 that I knew were
good. The 10th burger had
been sitting around for a few hours. I
thought it might be bad, but decided to take the chance.”
“You what?” I
asked, incredulous.
“You know I always try to keep my customers happy. What’s the fuss? Only one kid got sick, and all she got was diarrhea.”
Needless to say, I was flabbergasted. How much irresponsibility did he think was
acceptable in the name of satisfaction?
Whenever I tell this story, the response is typically an
incredulous look and a recommendation that usually is somewhat along the lines
of opinion that the owner of the stand should be boiled in oil.
Then I tell the truth:
This incident never happened.
It’s a parable I like to tell residents or medical students when we
discuss the unnecessary use of antibiotics.
You see, if you replace the word “hamburger” with “antibiotic,” and
replace “stand owner” with “family doctor,” the story is virtually the same.
When a doctor gives a patient unnecessary antibiotics
just to keep them happy, the doctor is doing exactly what the owner did. Same principle, and same consequences (actually,
probably worse since antibiotics wipe out much of the entire gut flora for a
long time). So why do most doctors think
the hamburger story is ghastly, yet continue to prescribe unnecessary
antibiotics?
According to the CDC* and the New England Journal of
Medicine** studies indicate that nearly 50% of antibiotics are unnecessary but
some patients are happier when we prescribe them. Yet antibiotics have a number needed to harm
(NNH) of about 10 if we define harm as antibiotic associated diarrhea (that
means that for every 10 people who take an antibiotic, 1 of those 10 will end
up with diarrhea). This is the same as
in the hamburger story. Of course, that’s
without counting the growing threat of antibiotic resistance and without
considering the likely longer term health consequences.
So, if you’re a patient, the next time you’re tempted to
demand antibiotics unnecessarily, consider this story. Or, if you’re a doctor, the next time you’re
tempted to prescribe an unnecessary antibiotic to keep a patient happy, tell
the patient this story instead.
Note: The
inspiration for writing this story came from an article in The Journal of
Family Practice, November 2013, Vol 62, No 11, Pg 620. I used their story and made it my own.
Medical Disclaimer: Information provided in this email is for informational purposes only. The information is a result of years of practice and experience by Yoshi Rahm, DO. However, this information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product label or packaging.
Do not use the information provided in this email for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read in this email.
Information provided in this email and the use of any products or services related to this email by you DOES NOT create a doctor-patient relationship between you and Yoshi Rahm, DO. or any other physician featured in this email. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
Medical Disclaimer: Information provided in this email is for informational purposes only. The information is a result of years of practice and experience by Yoshi Rahm, DO. However, this information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product label or packaging.
Do not use the information provided in this email for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read in this email.
Information provided in this email and the use of any products or services related to this email by you DOES NOT create a doctor-patient relationship between you and Yoshi Rahm, DO. or any other physician featured in this email. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
