This horrible medical advice is brought to you by the people I’ve heard actually give this advice many, many times.
“Oh, that cough sounds awful. How long have you had it? More than three days? You should definitely go see a nurse practitioner about that. You should always see nurse practitioners, because they can do everything a doctor can do and they’re more willing to make appointments with you. So hurry up and call your doctor’s office or health center to see someone about your cough.”
This was almost always followed up, a few days later, by this: “Did you see the NP? Great. Oh, it’s probably just a cough but they gave you antibiotics just in case? Good. That’s important. You’re taking care of yourself.”
Okay, so that was the horrible medical advice, and now I’m going to rant about explain why this is horrible medical advice, so I suppose I’m actually giving you good medical advice (note: see disclaimer at bottom of post), and I apologize for that but it infuriates me to no fucking end when people with no fucking clue about medicine give advice as if they have a fucking clue.
1: You have a cough. Do you have any other symptoms? Are you coughing up nasty shit? Are you unable to breathe because of the coughing? Do you hear weird rattling or fluidy sounds when you cough? If the answer to all of these questions is no, you probably have…A COLD. Don’t go to the doctor for a fucking cold unless your immune system is horrible or you’ve developed some sort of infection. If your other symptoms are sneezing and a runny nose, then it’s definitely a cold and you’re wasting your doctor’s time. Your doctor could be spending that time doing something important, like doing necessary check-ups with someone with a chronic illness or giving me migraine medication.
2: Nurse practitioners can’t do everything a doctor does. In fact, that’s exactly why they are “more willing” to see you. It’s not that they’re more willing, it’s that everyone fucking knows that when you go to the doctor you should go to the doctor. (No, not The Doctor, though I’m sure he could help if you needed it.) So they have more time because people don’t want to book their time as much. Nurse practitioners can do many things and they’re a valuable asset to most doctors’ offices, but a lot of the time, if there’s anything complicated or not very, very basic, they actually just call the doctor in for a consult. So then if you go in with a cough you’re wasting the NP’s time by being there with a cough and the doctor’s time if the NP thinks it might be something. I do love NPs. Don’t get me wrong. But they don’t go through four years of med school and then 3-8 years of residency to learn to do what they’re doing.
3: Health centers. I’m referring here to college health centers, where usually your only option is an NP and one that is barely qualified for the job, otherwise they would be working at a hospital or doctor’s office. College health centers are bullshit. If you’re in college and can possibly find a real doctor to go to, do it.
4: Antibiotics for a cough is the dumbest fucking thing ever. If you follow this advice and your doctor or NP prescribes you antibiotics “just in case it’s not just a cold,” find a different doctor or NP. You know those super-bacteria that are resistant to tons of antibiotics that everyone is afraid of? It’s shit like this that creates those bacteria. If you get antibiotics every fucking time you have a cough, you’re going to develop some fucking awesome bacteria that will kick most antibiotics’ asses and probably eventually end up in the ER because you got a damn papercut and it got infected by the stupid bacteria that you grew and nothing will treat it. You’re not taking care of yourself at all.
5: If someone gives you medical advice, ask them where they learned whatever advice they’re giving you. Things like “Oh, I read it in a magazine” or “They actually did a study” are not valid responses. (Also, if anyone tells you that chicken soup actually has medical benefits, tell them to shut the fuck up. All it will do is hydrate you a little and get you some nutrients, and even that only happens if it’s the good, home-made kind with lots of vegetables and no chemicals.) If the person is a medical professional or says something like “my doctor told me this” or “my boyfriend is a medical student and complains about patients who do this all the time because they’re essentially killing everyone” then their advice might be worth at least thinking about. If you’re not sure, call your doctor and ask if you should come in. Chances are, if you call your doctor and say “I’ve had this cough for a few days and someone recommended I make an appointment, do you think I should?” your doctor will probably tell you “No fucking way.” Well, something like that. If it’s something you wouldn’t normally go to the doctor about, make that “should I make an appointment” call before the “I’d like to schedule an appointment, please” call. You’ll save a lot of time and possibly also money and lives.
Disclaimer: I am not a medical professional; just a person who is surrounded by people who are medical professionals or are very close to being medical professionals. This advice reflects things they have told me but is not actually official medical advice. Thank you.
(Also: I’m now on Bloglovin’ and they’re requiring that I put this in a post: Follow my blog with bloglovin)
Oh, Rachael. 
I love this post! Everything about it is so true, and it annoys me so much!! Overuse of antibiotics is how you end up with shit like MRSA. And don’t even get me started on 99.9% effective disinfectants like Lysol! I mean seriously, do you really think the .1% of germs left over are the weak, everyday germs that really won’t do anything to you unless you’re severely immunocompromised? No, they’re the tough ones that can withstand disinfectants.
Oops, I said I wasn’t going to get into that.
From what I understand, the ones Lysol and stuff don’t kill off are still fairly easily treated with antibiotics–it’s a completely different method of killing them. I don’t know. Mike wrote an absurdly long explanation of how this happens below.
But yeah, I get rageful about antibiotic abuse, especially when it’s people dispensing advice (in this case, it was a professor to a group of impressionable students) that’s gonna screw everyone over in the long run. Especially in this case, really, ’cause those kids are probably ALWAYS going to go to the doctor for their coughs now.
Well, yeah, I guess in regular household situations using stuff like Lysol isn’t going to be a problem. We just had a lecture on spread of infection and blood-borne pathogens, so I’m a little paranoid about over/under/improper sanitation right now. The lady presenting was telling us all about how certain sanitizers are only effective up to a point. When you have something like TB or HBV or MRSA that tends to stay around even after using regular sanitizers, it can be really dangerous to just use something like Lysol. It’s important to use an approved disinfectant. I guess for the most part you wouldn’t really get that sort of stuff unless you at a hospital, anyways.
really, the major sources of antibiotic-resistant illnesses are the food industry (animals injected with antibiotic cocktails as a preventative health measure) and hospitals, not mrs. johnson down the street with her prescription for every little ache and cough. the inappropriate antibiotic prescriptions certainly don’t help, though, and they’re given out as placebo, which is silly. the medical community needs to come up with a placebo that’s actually a sugar pill, give is a fancy name like “placeebX” and start prescribing it for cases like those 🙂
ohhhh wait, that’s homeopathy. of course THAT’s “prescribed” for all kinds of illnesses that require REAL medicine, not just for sally’s sniffles.
basically, the world is full of stupid.
Okay, so Mike wrote up a ridiculously long explanation of how antibiotic resistance happens. I had no idea giving animals antibiotics did anything! I think the story’s different when people are older and have weaker immune systems; it’s when–as I mentioned in my reply to Emeee–college kids start taking antibiotics for everything. ‘Cause the old lady down the street might actually need them. 18-year-olds can fight off, and more importantly, PREVENT much more infection. Mrs. Johnson down the street probably gets infections all the time. Claire in my class (I don’t think I know any Claires) probably doesn’t.
Also, a lot of homeopathy is actually excellent. For example, using a neti pot for a sinus infection is always my doctor’s first recommendation, and if things haven’t improved after a few days he’ll prescribe something. It’s technically homeopathy. The way I see that is, if you CAN use it, you should. (And when no other sleeping pill would work for me and I was skeptical as hell about melatonin, it’s the only thing that’s worked long-term.)
But yeah, acupuncture may be great for some things but it’s not going to cure your cancer. In most cases, people definitely don’t use the two right. I’d love to see them used together, or the way my doctor uses them, more often.
Ugh, homeopathy drives me nuts. I think you’re confusing the terms “homeopathy” and “holistic medicine.” The neti pot isn’t homeopathy, it’s from ayurveda, which also drives me nuts but in this case makes sense–if you have an abscess, a doctor would incise and drain the pus then rinse out the abscess pocket with sterile saline to rinse out the remaining bacteria, so if you have bacteria or virus particles in your nose, rinsing out the “infectious pocket” with sterile saline makes sense. Melatonin has a similar argument in favor of it–your brain produces melatonin as part of the beginning of your sleep cycle, so if you can get the melatonin in pills to cross the blood-brain barrier, it should theoretically make you sleepy.
Homeopathy is bullshit. It centers around the idea that water molecules retain “memory” of stuff that was once dissolved in that water and that diluting a solution makes it more powerful. A decent summary is on Wikipedia here: http://en.wikipedia.org/wiki/Homeopathy The “Dilutions” section describes my point.
Oh. WHOOPS. Yeah, okay. Holistic medicine is cool when used appropriately (but it’s not always used appropriately). Homeopathy is bullshit. If water remembers everything ever, then it remembers being in the toilet a few years ago, and do you really want to drink that now?
Thanks for correcting me. I categorize all of them under “alternative medicine” and often can’t remember which is which.
Tehpet, antibiotics given to livestock are only part of the problem. Yes, it contributes to antibiotic resistance, but the main issue in human populations is how antibiotics are handled in human populations. The antibiotic resistance problem first cropped up when antibiotics started being used for things like “just a cough” and for reasons like “you probably have something viral (which antibiotics will not treat) but just in case let me give you antibiotics” and people started thinking “if I’m only taking these in case it’s not something more than a cold, the fact that I’m getting better means it’s just a cold so I can stop taking these antibiotics halfway through the course.” Patients stop taking their antibiotics far too early a LOT, and that is the single biggest factor to the increase in antibiotic resistance.
Quick explanation of how antibiotic resistance occurs: Each species of bacteria is susceptible to some antibiotics and not to others. Sometimes a species of bacteria is resistant to a particular antibiotic because they don’t have the protein that that particular antibiotic targets, or they don’t build their cell wall in a way that the antibiotic targets, or because they happened to have a metabolic enzyme (and the gene that codes for it) that breaks down that antibiotic and ones with similar structures (generally members of the same “family,” such as beta lactams [the family that penicillin belongs to] or cephalosporins). Bacteria can trade genes via a process called conjugation and they regularly do. “Acquired antibiotic resistance” happens when a bacterium acquires via conjugation with another species of bacteria the gene that codes for an enzyme that breaks down a particular set of antibiotics. All known instances of antibiotic resistance cropping up in bacteria that I know of happened by that method (including the particularly-scary ones like ESBL+ Klebsiella and VRE).
Now, conjugation is always occurring and in the normal exchange of genes, bacteria do exchange normal antibiotic resistance genes at a low rate. As a result, in any given population of bacteria, you will have a small number that are resistant to an antibiotic that the rest of that species is susceptible to. (This is why there is such a thing as community-acquired MRSA.) Normally, when all of your body’s flora are in balance, the percentage of antibiotic-resistant bacteria stays low and your immune system can handle them just fine along with the non-resistant bacteria. It’s when you stop antibiotics early that you get in trouble. Let’s say that you have normal Staph aureus on your skin and 99% is MSSA (non-MRSA) and 1% is MRSA. Let’s also say you get a cut and it gets infected with that population of Staph. You get prescribed a standard-for-skin-infections 10-day course of amoxicillin (which kills MSSA but not MRSA). You start taking it, and after 4 days you feel better–your fever’s gone, there’s way less pus and pain, the swelling has gone down, and you’re on the road to recovery. You then figure “eh, it’s pretty much better, I don’t need these anymore.” You’ve been killing off the MSSA, but not the MRSA, with the amoxicillin, and your immune system has been fighting both types. You’ve been killing MSSA at a much higher rate than MRSA, so now the population of Staph left when you stop your antibiotics is now 70% MSSA and 30% MRSA. Perhaps you ARE right, there are now few enough bacteria for your immune system to stave off until your cut heals, and you’re going to be just fine. However, normally-occurring bacteria populations, if not entirely eradicated by your treatment, do regrow to about their original numbers once you stop antibiotics. Once your normal skin bacteria reproduce and get their numbers back up to normal, you’ve now taken a population of normal skin bacteria that was 99% susceptible and 1% resistant to penicillins and made it 30% resistant to penicillins (that’s right, ALL penicillins, even the broad spectrum ones like Zosyn, or piperacillin/tazobactam). Because of this, the next time you get a cut, good ol’ amoxicillin may not do the job and you may end up getting a different class of antibiotics. If you stop the next class of antibiotics early, the same thing happens.
Now, you’re probably saying “Hey, that’s only if you have an infected cut. What if there’s no infection?” The answer to this is that we humans are colonized with many different types of bacteria all over our skin and all over our respiratory and gastrointestinal tracts. When you take antibiotics, they don’t just kill the bacteria in the infection you’re treating–they kill all susceptible bacteria everywhere that the antibiotic can go. If there’s no infection and you take antibiotics, you’re still killing the susceptible bacteria on/in your body and making the naturally-occurring resistant bacteria more concentrated. If enough people do this, we end up with a bunch of strains of normal bacteria that are resistant to various antibiotics, and it makes treating infections a LOT harder. The reason why this happens more often and more quickly in hospitals is that people there are sick–hospitalized patients with infections tend to have infections with multiple bacteria necessitating multiple antibiotics, many of which are bacteriostatic (merely slow the growth of bacteria rather than kill them) rather than bacteriocidal (kill bacteria). They also tend to be sick enough that their immune systems aren’t fighting very well–bacteriostatic antibiotics that require your immune system to vigorously fight take much longer to work in these patients and aren’t always successful. Take a very, very sick person whose body can’t fight infection well and increase the number of antibiotic-resistant bacteria and you’ve got yourself a recipe for a crapload of antibiotics followed by continued infection followed by fungal superinfection (because the normal gut and skin flora keep the fungi that are all around us in check by outcompeting them and when you kill off the normal flora with the antibiotics you’re using to treat a life-threatening infection then the fungi can run wild) followed likely by death.
Another major part of the problem is that we in the medical field still tend to transfer bacteria from patient to patient on things like our white coats and stethoscopes, which can be prevented with good hygiene habits. For some reason, though, we still suck at doing things like sanitizing our hands when we go into and out of every patient encounter and wiping down our stethoscopes with sanitizer wipes and stuff. This is a separate rant of mine.
So yeah, giving (old and cheap) antibiotics to livestock is only a miniscule part of the problem of bacterial resistance to (many classes of) antibiotics. The problem we’re seeing now isn’t that Zosyn doesn’t work–we know that. The problem we’re seeing is increasing resistance to the broader-spectrum drugs like cephalosporins, quinolones, and carbepenems. The current “big guns” that we’re starting to see resistance to are still pretty expensive, and so I have a feeling the livestock industry isn’t using them on chickens and cows.
Mike, thank you for taking the time to write out this detailed explanation. If my readers are anything like me, they love knowing why and how shit works.
For any readers out there looking at this and going “TL;DR” in your heads, a summary: don’t get antibiotics unless you’re reasonably sure there’s an infection, and don’t EVER stop taking your antibiotics before your doctor tells you to, because that’s how superbacteria happen.
Wow, thanks for the detailed explanation! I knew stopping antibiotics before you finished them was bad, but I never really knew why.
This is both fascinating, and an indication of why I am becoming an occupational therapist, not a doctor. I don’t have a head capable of holding that kind of information in detail. 😛
awesome explanation, Mike. i’m actually a microbiology student, so i already knew all of what you posted, but it’s interesting that in my classes (not human-disease oriented) i’ve been told that the greater issue is livestock antibiotic use. i suspect that in my classes they are referring to *all* antibiotic resistant bacteria and not simply the human pathogens, thus weighting the numbers differently. in that case, they are also including strains which have the potential to jump organisms (avian and pig strains of influenza, for instance) but which have not yet done so. these would then be diseases which are not yet (and may never be) medically relevant. certainly for human pathogens the inappropriate use of antibiotics is the major factor.
sometimes i forget that most people care about human context and not the wee buggies themselves 🙂
I have to confess that the only parts of Mike’s awesome explanation I read were the parts that had LOT all in caps like that… because in skimming I read LOT as LOTR and was suddenly interested.
/nerd
lac, that is the wrong kind of nerd.
not saying lotr isn’t awesome, but it’s not as awesome as horizontal gene transfer.
yeah, i said it.
*bows to tehpet, Queen of Bio Nerds*
Oh my god. Imagine if LOTR and biology, like, cross-bred. I wonder what the phenotype would be–geek or nerd. Hm. WELL THEN. It looks like we know which side of THIS nerd vs. geek battle I fall on.
(But I bet Gandalf could kick MRSA’s ass.)
YOU SHALL NOT INFECT!