Medicine
At December's annual meeting of the North American Primary Care Research Group (NAPCRG), fellow American Family Physician editor Mark Ebell, MD, MS presented the findings from a study that provided an original take a seemingly simple question: how long does a cough last? This study compared patient expectations with a systematic review of the medical literature.
Dr. Ebell's team surveyed a sample of patients and consulted "Dr. Google" to determine public perceptions of how long a cough from an acute upper respiratory infection is supposed to last. Although estimates varied, the most common answer was one to two weeks. His team then proceeded to review the medical literature for studies of the natural history of acute cough, using the control groups from randomized trials testing an intervention such as an antibiotic. The weighted mean duration of cough in these patients was actually 17.8 days.
Since antibiotics are prescribed for at least 50 percent of patients who visit doctors for acute cough, Dr. Ebell suggested that the substantial discrepancy between patients' expectations and the actual duration of acute cough caused by respiratory infections may be a driver of excessive antibiotic prescribing. If more patients knew that a cough could normally last for two weeks or more, perhaps fewer of them would seek medical care for self-limited illness. (As one of my colleagues observed with a smile after hearing about Dr. Ebell's presentation, "Cough from acute bronchitis is expected to last for 2 weeks. With antibiotics, it only lasts 14 days.")
Update (1/15/13): this research study was just published in the January/February issue of Annals of Family Medicine.
**
A slightly different version of the above post first appeared in the AFP Community Blog.
- Antibiotics For Acute Appendicitis
Until recently, the most well-studied clinical questions about acute appendicitis have been how to efficiently diagnose it using the history and physical examination and laboratory and imaging tests. Once appendicitis was identified, the next step...
- Antibiotic Overuse: Truth And Consequences
The cover article of American Family Physician's March 15th issue, "Common Questions About Clostridium Difficile Infection," reviews truths about a disease that is a direct consequence of medicine's good intentions: antibiotic use, both appropriate...
- Checking The Resurgence Of Pertussis (whooping Cough)
According to recent news stories, more than twice as many cases of pertussis have already been reported in the U.S. this year than in all of 2011. Although some of the resurgence of the infectious organism that causes whooping cough may be due to...
- Guest Blog: Morbidity
Dr. Ed Pullen is a family physician who practices at Sound Family Medicine in Puyallup, WA. The following piece is excerpted from a previously published post on his blog, DrPullen.com. ** When I was a first-year medical student, the term morbidity was...
- Antibiotics, Sinusitis, And Swine Flu
For the past few months, the Giant supermarket chain has offered a free supply of certain antibiotics to customers with a doctor's prescription. As a family physician who is always explaining to patients why antibiotics are ineffective for the common...
Medicine
How long does a cough last? (longer than you'd think)
At December's annual meeting of the North American Primary Care Research Group (NAPCRG), fellow American Family Physician editor Mark Ebell, MD, MS presented the findings from a study that provided an original take a seemingly simple question: how long does a cough last? This study compared patient expectations with a systematic review of the medical literature.
Dr. Ebell's team surveyed a sample of patients and consulted "Dr. Google" to determine public perceptions of how long a cough from an acute upper respiratory infection is supposed to last. Although estimates varied, the most common answer was one to two weeks. His team then proceeded to review the medical literature for studies of the natural history of acute cough, using the control groups from randomized trials testing an intervention such as an antibiotic. The weighted mean duration of cough in these patients was actually 17.8 days.
Since antibiotics are prescribed for at least 50 percent of patients who visit doctors for acute cough, Dr. Ebell suggested that the substantial discrepancy between patients' expectations and the actual duration of acute cough caused by respiratory infections may be a driver of excessive antibiotic prescribing. If more patients knew that a cough could normally last for two weeks or more, perhaps fewer of them would seek medical care for self-limited illness. (As one of my colleagues observed with a smile after hearing about Dr. Ebell's presentation, "Cough from acute bronchitis is expected to last for 2 weeks. With antibiotics, it only lasts 14 days.")
Update (1/15/13): this research study was just published in the January/February issue of Annals of Family Medicine.
**
A slightly different version of the above post first appeared in the AFP Community Blog.
- Antibiotics For Acute Appendicitis
Until recently, the most well-studied clinical questions about acute appendicitis have been how to efficiently diagnose it using the history and physical examination and laboratory and imaging tests. Once appendicitis was identified, the next step...
- Antibiotic Overuse: Truth And Consequences
The cover article of American Family Physician's March 15th issue, "Common Questions About Clostridium Difficile Infection," reviews truths about a disease that is a direct consequence of medicine's good intentions: antibiotic use, both appropriate...
- Checking The Resurgence Of Pertussis (whooping Cough)
According to recent news stories, more than twice as many cases of pertussis have already been reported in the U.S. this year than in all of 2011. Although some of the resurgence of the infectious organism that causes whooping cough may be due to...
- Guest Blog: Morbidity
Dr. Ed Pullen is a family physician who practices at Sound Family Medicine in Puyallup, WA. The following piece is excerpted from a previously published post on his blog, DrPullen.com. ** When I was a first-year medical student, the term morbidity was...
- Antibiotics, Sinusitis, And Swine Flu
For the past few months, the Giant supermarket chain has offered a free supply of certain antibiotics to customers with a doctor's prescription. As a family physician who is always explaining to patients why antibiotics are ineffective for the common...