Sometimes A Cold Is Just A Cold

young female having a coldWe’re all human. When we get sick, we want symptom relief. We all want a pill to make us feel better. Pills are easy and they’re everywhere. It’s time that we don’t have. We don’t have time to feel so bad. The problem is, humans suffer illnesses. Some smarter than me have said that illnesses and pain are symptoms of being alive.

In general, we can break the cause of these illnesses into bacteria and viruses. Bacteria may get better with antibiotics (keep reading), but viruses don’t. Most common sicknesses are what we call self-limited, meaning they’re going to get better whether or not you see your doctor. When you’re sick with a cold (caused by a virus), even a really bad cold, you plead with the doctor to give you an antibiotic. You may even find some old antibiotics lying around. You pray to the god of whatever –cillin drug you ingest, and you do get better. Eventually. Yet again, you suffer the delusion that the Z-pack made you better.

The problem with that? You were going to get better in the same amount of time anyway. Yes, I know you got better with the antibiotic, but your body was already fighting the virus. Your immune system was making you better.

Even some bacterial illnesses have shown they don’t necessarily need antibiotics. Studies show most ear infections get better without antibiotics. So, really we should start off just treating the pain from the ear infection. Sore throats? Most of them get better on their own. Steroids can help the pain of a sore throat. Bronchitis is another common ailment. So, you’re coughing up thick green stuff and running a low-grade fever. Antibiotic? Not helpful, unless you have a chronic lung disease, or it’s actually truly pneumonia that you’re dealing with.

What’s the harm in getting more of the same antibiotic that helped you last time? Well, the harm is multitude.  First, dispensing antibiotics to anyone with a sniffle means that those antibiotics are circulating in your body for all the bacteria to figure out ways to be resistant to it next go round. It’s like we’re letting the enemy know the game plan for how we’re going to combat them in the future. They are taking notes. That’s why each year hospitals have to release reports about what percentage of the bacteria are still sensitive to the drugs.

Most people don’t really care a lot about antibiotic resistance, especially in the short term when they feel terrible. But, there is still the potential for things we all care about: diarrhea, allergic reactions, rashes, and pregnancy. Diarrhea? Sometimes only a minor inconvenience, other times it can be so severe it leads to hospitalization. Pregnancy? Yes, some antibiotics can make oral contraceptives less effective.

So, herein lies the rub: as your physician, I want to do the right thing for you, but in today’s climate, I need to do that in a way that you don’t evaluate me poorly because of it. It’s easier for doctors to do the wrong thing. It’s easier to prescribe antibiotics that aren’t needed because we think that’s what our patients want, and we’re usually right about that. It’s also less time-consuming to write a prescription than to explain all the reasons why antibiotics won’t be helpful. So, some doctors prescribe. Personally, I like to educate my patients on why I think the therapy they’re seeking may be harmful.

How can we differentiate what needs antibiotics ourselves? Well, obviously that’s challenging to summarize in a blog. I went through a lot of training, and I still sometimes have legitimate trouble sorting it out. In general, I explain to patients that bacteria tend to cause fever and fairly local symptoms: fever and sore throat, fever and cough, fever and earache. When your symptoms cover multiple systems, such as fever, achiness, congestion, cough, and sore throat, that usually suggests to me it’s a virus, and antibiotics are off the table.

If you feel bad, it’s usually reasonable to give it a couple of days to see how you’re doing. If you find you’re rapidly getting worse, go see a doctor. If you’re symptoms have taken you beyond inconvenience and you’re legitimately worried, go see a doctor.

So, how can we save some time and money? My advice is the next time you have a cold, even if you really feel bad and are tired of having a cold, think twice before going to the doctor. If you do have some symptoms that are worth getting checked out, or maybe you need some symptom relief, at least be open to the idea that antibiotics may be exactly what you don’t need. Understand that a good physician still has your best interest at heart.