It Was Just a Cough: Wasteful and Potentially Harmful Medicine

Over his recent winter break, my 26-year-old son went skiing in Idaho. Fully insured on COBRA, he went to a free-standing urgent care facility in his small resort town for a cough. No culture was taken and he was never asked if he was taking any medications (which he is), but he did receive the following:

1. A chest x-ray
2. An asthma inhaler
3. Antibiotics
4. A prescription for a cough suppressant

Armed with knowledge about the Choosing Wisely campaign and the dangers of overuse from conversations with his dad, he stopped taking the cough suppressant and never used the inhaler (his cough was gone by the time he returned from his trip and he is fine now). He paid $100 out-of-pocket for all services – neither one of us know what the total itemized bill actually was.  Cost aside, what worries me is the potentially unnecessary harm to my son:

• Taking antibiotics puts him at risk for antibiotic resistance as well as having an adverse impact on the general population from the overuse of antibiotics.
• He was exposed unnecessarily to radiation, which may have large cumulative effects down the road.
• He was prescribed a cough suppressant over an equally effective over-the-counter medication.

I asked him why he didn’t challenge the doctor regarding his treatment of what I presume was a viral infection. He replied, “Dad, how could I question the doctor? He is an authority figure with all of the knowledge. It’s hard for a patient to argue with their physician, particularly when they’re not feeling well.”

My son’s experience points to the challenge patients face of avoiding unnecessary care when presented with a physician’s recommendations. Do we place too much responsibility on patients to say no in the face of the expert?

The Choosing Wisely campaign aims to work with both patients and physicians regarding the recommendations of tests and procedures to avoid and have a joint informed conversation regarding what is best for the patient. In my son’s case, there was no such conversation. It is clear to me that our next step in the campaign is to get the recommendations from more than 30 specialty societies in the minds of all practicing clinicians and the Consumer Reports translations of these recommendations to all patients at the point of care so these types of conversations can occur.

Daniel B. Wolfson
EVP and COO, ABIM Foundation