Health & Wellness Best Posts in Thread: Antibiotics

you know, this is just another scary story. it appears to me that the culture here does not support open criticism, either constructive or destructive. i conjecture therefore that quality improvement basically does not exist because no one wnats to take the position that something was done wrong and that there is a better way. it seems to be that generally speaking, filipinos are wedded to their traditional ways and to their conventional wisdom. if it was good enough for grandpa, its good enough for me. just thinking and wondering how this issue works within the medical community.

 

yup, it is astonishing if true. i think perhaps the study was done in 2015 and perhaps published in 2018 or something like that. i have no doubt the system would have lots of effort to try to discredit it but johns hopkins is sort of the gorilla in the room in US healthcare and as far as i know the study still stands intact.

my personal takeaway would be to use your brain and good judgement in entering any healthcare system. i want to believe doctors et al. are more good than not but there is no question that the US system is driven by profit motive and all of the people in it have mortages and kids in college and poo poo undies just like the rest of us.

we are all responsible for our own health and just because you hire a doctor does not relieve you of that responsibility. one of the biggest problems is that health insurance and "universal coverage" takes your personal financial incentive out of the picture. its much easier to demand that "everything be done" if you are not paying for it. i also believe its true that the US now has more attorneys than doctors which just adds another layer for conflict.

avoiding risk in the first place is the best rule for any human activity, and expose yourself to risk only when you have no reasonable alternative.

 

For those with young children I would recommend a book written by the late Dr. Hugh Jolly, who was the chief medical officer at a large children's hospital in London, UK. He advocates common sense and doesn't patronize parents like some other authors do.
The "Book of Child Care: Complete Guide for Today's Parents" is sadly out of print, but not hard to still find copies of.
The book excels in advice when your child is sick.

 

I agree. When we blindly follow a doctor’s advise without using our intuition snd not seeking a second opinion we are not only throwing away money but also risking our lives. My sister was also in such a state. She was scheduled for surgery because the doctors could not determine the cause of her stomach pains in spite of ultrasound etc.This was at SUMC. She underwent that surgery and was billed more than a hundred thousand pesos. After a few months the pain recurred. She went back to the hospital and was advised to go to Manila as they could no longer fix the problem. She decided to go to Cebu and had another surgery on the same area. The doctor in Cebu wondered what the previous doctor did when he saw the cause of the problem and removed it. They paid less than 40k for the 2nd operation which finally solved her health dilemma.

 

Inflamed vein is phlebitis. A family member of mine had that and eventually had a limb amputated.

I am pleased the hot compress worked but, if not treated correctly, phlebitis can lead to thrombosis (blood clot) and death. The medical literature recommends compression stockings (these, as used when an air passenger or being immobile too long, help prevent deep vein thrombosis (DVT)) and it also recommends cooling the inflamed area (which tends to contradict the doctor's recommendation for heat).

A good example of why to seek medical help, even if it requires a second opinion. Btw, I am a great fan of my own opinion and at least two doctors' opinions when serious matters are involved. It can prevent unnecessary treatments (any invasive treatment, physically or pharmaceutical, can be a danger in itself) and spending money unnecessarily. When I had been here not very long (so not really aware of what goes on) my asawa saw a local 'well respected' doctor and was advised to have surgery - it was not urgent but he arranged it for 2 days after the consultation (before minds could change)! I felt he was rushing her and advised her to get a second opinion - she felt the doctor knew best and so went in for the op. There was a post-operative problem which he failed to diagnose correctly - in fact, my diagnosis was accurate (his registrars knew he was wrong but admitted they were scared to say as he would shout at them). I advised my asawa to get this 'problem' corrected by a different doctor.

First doctor (the one who messed up) P83,000
Second doctor (who sorted out the problem) P5,000.

The 'problem' was actually the original problem! P83,000 to have nothing achieved for the patient.

The first doctor might be 'well respected' but I guess is very wealthy. So, as most know, all professions make money - be careful to understand if treatment is necessary or is recommended as a way of inflating the bank balance. Just like some divorce lawyers want the couple to destroy each other over a long drawn-out battle in Court.

 

When a doctor prescribes antibiotics, it is based on his best guess with regard to the (bacterial) infection that the patient has.
And yes, if they don't work (because the bacteria is a different strain or resistant against some antibiotics and therefore a different type of antibiotics needs to be applied) then the doctor will prescribe a different type of antibiotics afterward.
The problem is that finding out which bacteria cause the problem and whether it is a resistant strain before prescribing antibiotics involves two things:
1. (quite a bit of) time (for the laboratory stuff) and
2. (quite a bit of) money
A doctor can not see from the outside of a patient what bacteria causes a problem and whether that bacteria is resistant against antibiotics a, b or c, he's a doctor, not a magician.
So blaming the doctor for "wrong diagnose" in such cases is a bunch of rubbish.

The doctor (and a reasonable patient also) will choose to treat the patient with the best option that will likely work, rather than send the patient to a laboratory first, then wait for the result while the patient gets sicker, make the patient pay for the laboratory stuff and only then prescribe an antibiotic that has a better chance of working.

If you wish to educate yourself about the problems with antibiotics, this would be a good start: https://www.idsociety.org/globalass...ibiotic-resistance-infographic-2016-final.pdf

 

"Tummy ache" (abdominal pain) could be a simple cause and will disappear but "About 15% of people have a more serious underlying condition such as appendicitis, leaking or ruptured abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy." (https://en.wikipedia.org/wiki/Abdominal_pain)

Untreated appendicitis, aortic aneurysm, ectopic pregnancy can be killers - I know personally from experience as a Haematologist that a ruptured aorta needs more blood for immediate transfusion than I think a person here could collect in a month.

I await the response from some that only idiots would not know the difference between a 'tummy ache' and a serious condition - I worry about the vast number of 'idiots' (ill informed) who populate the world but will agree that we do not rush off to surgery for a mild ache. However, no-one should be too complacent as 'time is of the essence' in many acute medical conditions.

 

There is confusion about over-use of antibiotics.

The expert opinion is that doctors prescribe them too often and so there are too many opportunities for them to allow resistant organisms to form (primarily bacteria and fungi (although fungal treatments are usually termed anti-fungals)). The fact that some people do not finish the course of antibiotics encourages resistant strains to emerge as the shorter treatment course just kills off the weaker organisms. This is a sort of under-use by the patient but the actual problem is over -use. The development of resistance to antibiotics is simply a form of natural selection from survival of the fittest.

The use of antibiotics as growth supplements in cattle and other livestock and the improper dumping of antibiotics by pharmaceutical companies makes the situation even worse.

New antibiotics are not being discovered fast enough to replace the ones which now have limited use due to resistance to them. There is discussions about powerful computers/AI being able to create new ones synthetically, as most originated from natural sources ( as with penicillin from a fungus). Also, viruses are being thought about as they can kill bacteria (these type of viruses are called bacteriophages) as effectively as they can kill humans!