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How to Talk Your Doctor into Prescribing You Antibiotic, by Dr. Cynthia Koelker

First of all, don’t use those words.  Doctors don’t want to be “talked into” something that they may not want to do.  You’ll need a better approach.
 
Secondly, if you tack your request on to the end of an office visit, it will not be granted.  At this point your doctor is ready to move on to the next patient and will not appreciate the delay.  You don’t want your doctor irritated with you when you ask him a favor.
 
So how does one meet with success? 
 
Basically you need to enter the doctor’s “world” and see things from the physician’s perspective.  Every doctor I know faces time constraints.  As a group we feel pressured (and aggravated) when we’re asked to do the work of two or three problems in the time allotted for one. This results in one or all problems being insufficiently addressed.  A request for antibiotics for TEOTWAWKI requires discussion, not simply jotting an Rx for amoxicillin. Next, the doctor-patient relationship is one of trust.  If your doctor has reason to distrust you (missing appointments, being untruthful, misusing your meds) he probably won’t trust you with extra antibiotics either. 
 
If a patient were coming to me with such a request, I’d prefer the conversation go something like this:
 
Patient:  “Hi Doc, thanks for seeing me.  I’m here for my (back, sore throat, etc.) and have one other question for you.” (This sets the stage with an appreciative tone and also the expectation of exactly two problems – not more.  Doctors always like to know at the beginning what they’re facing.  Two is the limit most are happy with.)
 
Patient:  “I’ve had (the first problem) for (time period). It seems to be getting (better/worse).  It might be due to (heavy lifting/infection/etc.) I’ve tried (OTC meds/rest/exercise) which has (helped/not helped).  In the past (what has helped.)  I’d like (pain meds/X-rays/blood work/etc.) or whatever you think might help me.”  (Keep it short.  Be as exact as possible. Don’t drag in extraneous information or what your Aunt Matilda advised.)
 
Doctor:  (Doctor addresses problem and prescribes solution.)
 
Patient:  “Thanks, Doc, I’ll do that.  Now my other question is this:  I’m very concerned about where our country is headed.  It doesn’t look like we can trust the economy, and I’m worried that if things go really bad, we’ll all be on our own.  I want to be able to take care of my family and have stocked up on food and other essentials, including a medical kit.  One thing I’d really like to have on hand is a supply of antibiotics, just in case.  I certainly would not use them unless no doctor is available.  Do you think you could help me out?  I do promise not to use them as long as you’re here to help me.  Could you write me a 10-day supply of generic Keflex, Cipro, and a sulfa drug?  From what I read, that would be a good place to start.” (Again, be concise, direct, appreciative, respectful, reassuring, and specific in your request.  You may want to bring along this article to share with your doctor.)
 
Doctor:  (hesitates)
 
Patient:  “If you’re worried whether I’d know how to use them, I have (a PDR/Sanford Guide/other reference book) to guide me.”  Shows you’re serious and have looked into the matter.
 
Depending on the doctor’s reaction – watch his or her face and body language – you may want to downgrade your request at this point to a single antibiotic, or ask the doctor which one they’d recommend to have on hand.  This engages the doctor in the process.  If it’s a no-go, still thank the doctor and try again on a return visit.
 
You’re even more likely to meet with success if you schedule a visit for this specific purpose only.  Don’t try this with a surgeon, ER doc, or Urgent Care physician.  It needs to be someone who knows you, most likely your family doctor.  If it’s the only request you have, they’re more likely to grant it.  Insurance may or may not pay for such a visit.  You need to consider this ahead of time and explain that you’ll pay cash if needed. 
 
A 10-day supply of these three antibiotics costs only about $12 at the discount pharmacies, and in fact may serve to cover more than three illnesses.  Although doctors always advise to finish your antibiotics, patients often don’t and most of them are okay.  Five days of antibiotics is often sufficient for sore throats, skin infections, respiratory infections, and urinary tract infections.  (More specific recommendations may be found at my web site.)
 
I’ve chosen cephalexin (Keflex), ciprofloxacin (Cipro), and trimethoprim-sulfamethoxazole to recommend because these cover most infections you’re likely to encounter.  Cephalexin is good for strep throat, ear aches, respiratory infections, some community-acquired pneumonia, some urinary infections, and most skin infections.  Ciprofloxacin is effective against urinary infections, some respiratory infections, infectious diarrhea, not to mention anthrax.  Trimethoprim-sulfamethoxazole usually covers outpatient methicillin-resistant staph infections of the skin and elsewhere, as well as urinary infections and many respiratory infections.  This list is by no means complete, but does include the most common infections. 
 
If your doctor agrees to your first request, on your next visit request a second set.  Three other antibiotics to consider include erythromycin (good for pneumonia, respiratory infections, pertussis, certain STDs, some skin infections), doxycycline (also good for respiratory infections, tick-borne illness, Chlamydia), and metronidazole (good for C diff, certain STDs, diverticulitis (in combination with ciprofloxacin or a sulfa drug), amoebic and certain helminthic infections).
 
A few more tips to find your doctor in a receptive mood:
 
1.      Schedule your appointment early in the day, preferably within the first hour.
2.      Try to avoid your doctor’s busiest day of the week – ask the receptionist for advice.
3.      Avoid holidays – though your doctor may feel more generous around Christmas.
4.      Try scheduling on your own birthday – and bring up this fact if it seems appropriate.
5.      Schedule when disaster is in the news – tsunami, earthquake, pandemic, etc.
 
Of all the above considerations, most important are 1) the relationship with your doctor and 2) designing your appointment to allow time for the discussion.  If you take your request seriously, so will your doctor.  If you act like it’s a joke, your doctor may merely laugh.   


Cynthia J. Koelker, MD


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SurvivalBlog.com on 23 April 2012

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