by Dave Mittman, PA, DFAAPA
A number of weeks ago a bunch of couples went out to dinner. One happened to be a dentist and one an optometrist. The dentist does not live in my area and I did not know him well. Both of them were male. When we all arrived at the restaurant the guys sat with the guys as we sometimes do as we were talking sports and the women sometimes find our conversation boring. It seems that the optometrist caught a very dry cough that sounded like a tracheo-bronchitis a month before while away and it had never left. He went to his physician two weeks prior who prescribed an antibiotic (a Z-Pac, I think) which as you all know well is widely prescribed across the USA for almost anything from dandruff to “it helped my mother in law”. As we were talking about it, I said that it SOUNDS like a virus and that he should take some cough medicine and stay hydrated. It will go away in time-it undoubtedly was a virus.No fever, no chills, etc. Especially because he had taken an antibiotic and it had done little to help. The dentist said that he should take Levaquin because it worked against viruses. After collecting my thoughts and debating whether to butt in after that, I gently said it would not work against viruses or colds and Levaquin came with some serious side effects that were not worth the risk benefit ratio. I explained how it effects tendons and that it could really have some serious side effects. While I do not scrape gums, or pull teeth, nor do I prescribe glasses or refract eyes, I have all the respect in the world for the professions that do. The problem in this case is that I have more experience as a clinician treating viruses, coughs and colds than my two colleagues at the table. They seemed to believe me, but not to care. I gave reasoned scientific responses why Levaquin was not indicated and suggested he go back to his physician to follow up. The dentist kept trying to look up Levaquin on his phone to prove to me that it works against viruses. At one point we discussed anthrax. Yes, I said, it works against anthrax.
I subsequently saw the Dr. with the cough who told me he was given an Rx for Levaquin. He took it for five days without any appreciable difference to his cough. I don’t know but presume it was written by the dentist. They both knew I was against it.
I was bothered. No, he was not my patient. And no, neither had any reason to listen to me beyond my experience and in this case, correctness. But why did this happen?
Is this just me being over sensitive as a PA? Or is it really two people who should have listened to the more experienced practitioner (on this one) not listening because he was not a “Doctor” as they were, and in fact at the end of the day an “assistant”? Or is it that people want what they want and when they can get it they will take it? If I was an MD internist would it have mattered if I said don’t take it? I am not sure but you know where I am leaning on this one.
I have to tell you, I was irked by it. I really tried to watch out for a patient and felt inconsequential in this outcome.
Again, this is not about other professions per se, it’s about perceptions, real or not.
What’s your opinion?
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.