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That's somewhat been going on for years, partly due to good (or too good) marketing, or samples you have on hand already that you can give the Pt. to take stat and write a follow up Rx for, also the physician's interest in the best care for the Pt. and the most rapid and effective cure, etc. There's no mean and nefarious conspiracy behind it; if anything, prescribers these days (physicians, PA's, NP's, etc) can really get beat up by HMOs and other managed care situations; in fact, the pressure is a little too great now in the other direction, where price is more important than efficacy.

I think the news that shocked the world, or at least a piece of it, that is, the emergence of strains resistant to Eli Lilly's Vancomycin, which was always supposed to be held in reserve as last resort, kind of jolted everyone into realizing the newer antibiotics should be reserved for use when first line defenses fail, and you better have your trenches well dug and plans for if the Enemy breaks the first perimeter.

I also hope it brings a renaissance of in-office susceptability testing, or, sending it out, though that costs more to everyone.

Years ago, when my Stepfather was actively practicing, if he had an acute "strep" or ENT infection patient, or an apparent skin or other infection, gather swab samples, swipe the (very easy to use, even a Doctor can do it! (ducking) culture media), drop an array of disks impregnated with micrograms of various antibiotics as well as swabbing a couple different culture media.

Then he'd prescribe a few days worth of the most conservative antibiotic that he thought PROBABLY was on target, to get the poor pt. started on something, as well as of course other meds, for pain, cough, expectorants, decongestants, whatever; and of course an ointment or cream for apparent dermal infection as well as P.O. meds.

When the culture results were done, if he found what he prescribed wouldn't help kill the germ nearly as well as something else, or maybe not at all, he'd call in the different med; if he was on track, he just called in 2 weeks worth of whatever, alerted the patient either way, and had them come in for an OV in a week, or call or come in sooner if things got worse.

Of course, if NOTHING appeared to be efficacious, it was time for the labs, consulting with whoever, and ensuring he wasn't completely off the railroad tracks.

He probably was the hardest sell for drug route salesmen/saleswomen; usually samples mailed to us at home or the office, or brought in by the reps ended at home in a great big box our dishwasher came in. Stuff he thought was really good for the right pt., we glommed all the starter doses together in batches for a full course of therapy for a patient, and he saved these for the uninsured, indigent patients that didn't have the resources to afford the medicine.

He also bought things like ampicillin, tetracycline, erythromycin, other commonly used drugs by the 1M bottle (1000 doses) from generics people, and dispensed them to patients who couldn't afford the medicine on their own, at no charge. (The stuff cost pennies to him.)

To be fair, the samples that worked really well, he did prescribe. Dubious things built up in the Box and were used by the family when appropriate. (Can you imagine they used to send out diet pills in the mail, to our house? God help us if someone decided to open our mailbox right by the side of the road.)

After being given Talwin for the pain from a severe ear infection, after I got done vomiting the 2nd or third time, I suggested "maybe this isn't the right medicine for everyone; I'd rather die from this pain than take another one of those pills."

These days, I wonder how many doctors practice medicine the same way my Stepfather did, and whether that's a good or a bad thing. I do think most prescribers are not mindless drones who pick the newest, most expensive pill or drug to prescribe, though.


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