Come back SOON!! An excerpt from Dr Mike's 2nd Book - entitled "NO ONE IS COMING... You are enough" - for brand new providers.

I’m sure you have had it grilled into you that you never prescribe an antibiotic without a visit.  I can tell you that in day to day primary care, this happens a great deal.  Often a patient will call with UTI or “bronchitis” symptoms, and another classic, “I think I have a sinus infection”.  Many times, the patient is just trying not to miss work because they don’t have the benefit of “sick days”.   

Instead of ALWAYS refusing, find out what is going on, and if you can get an antibiotic started with a scheduled follow-up in the following 7 days, you will demonstrate great concern for their life situation, while keeping the patient on your radar, and assuring that your original RX was appropriate.  Remember that the number one goal is to avoid ED utilization, so following a plan such as this will keep them from heading straight to the ED right after they get off the phone where you told them “No”.   

Early follow up also serves a valuable purpose in the patient/provider relationship.  The request to come back quickly fosters a sense of solidarity between the two because of the unspoken message, “not only are you not a bother, but I want you to keep coming back until we figure out what is wrong.  We will work this out together.”  The patient also feels a heightened sense of worth to the provider because if you are bringing them back quickly, you obviously A) think something is wrong, and B) care enough to make sure the nothing bad happens. 

Does this sound a bit “duh huh?”  That is EXACTLY the point, the obvious gets lost in the struggle to “be 100% right and never miss a clinical diagnosis.” The magic of the patient/provider relationship is that being super smart is genuinely less important than being super caring.   

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