Just give me a Zpack – what’s the harm?


“This turns into (bronchitis, pneumonia, etc) every year – I just need…”

“I don’t have time to be sick – just give me a Zpack and I’ll be fine.”

“But that pack thing worked the last time I had this!”


If I had a dollar for every time I heard some variation of those phrases uttered in my urgent care, I could probably retire now.  Patients come in with an agenda – they believe that they know what they have, even though they have been sick for a grand total of 6 hours, and that what they want will make them better by tomorrow.  Never mind the studies that you can quote, the informative handouts that you can give them saying that what they have is most likely viral and will run its course, or the horror stories that you tell them about antibiotic resistance or C. diff colitis.  They want what they want, and they want it now.

Being in urgent care or emergency medicine is a bit different than being in primary care in that I don’t often get to form relationships with my patients – they are in and out of my life in an hour, sometimes never to be seen again.  I did primary care for years, and I knew which patients I could trust to call me if their symptoms got worse, or which ones I could be straight with and tell them flat out that “you have a virus – you know that you do, so why are you looking for a quick fix?  Take some Sudafed and Mucinex and call me in two weeks if you’re not better”.  Some patients in urgent care can exaggerate their symptoms to seem sicker than they are (although vital signs don’t lie) or turn a two day cold into a three week cough – because they know that two days of symptoms won’t get them what they want.

What’s the harm in giving them what they want, you ask?  Besides the obvious – resistance, C. diff, possible adverse reactions to unneeded medicines – it chips away at our principles.  It wears us down, it pokes another hole into our already deflating integrity.  There are enough outside forces pushing on us, making us ready to collapse.  The patients – the reason that we are here – shouldn’t be one of them.

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