Treating Diverticulitis Without Antibiotics? Let's Negotiate!

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Some time ago, I penned a post illustrating the common practice of physicians negotiating with patients.  Here, I will offer other examples of this phenomenon, which is an integral element of the doctor-patient relationship. Patients who understand how this process works will have an additional tool to advocate for their health.

These negotiations are give and take exercises that are successful when both parties feel good afterwards.

Realize that these negotiations are different from conventional business discussions which tend to be zero sum games between adversaries.  In the doctor-patient scenario, both participants’ interests are aligned; both are on the patients’ side. 

Finally, for a negotiation to succeed, each side must be willing to be flexible and reasonable. We must also recognize that there will be red lines that cannot be crossed.  Consider this hypothetical example:

Physician:  Jim, I strongly suspect that you have acute appendicitis.  I’ll have a surgeon meet you in the emergency room.  I think you may need surgery today.

Jim:  Doc, I have an afternoon flight out of town for a playoff game.  I’ll be fine.  Can I just take a shot of penicillin or something?

It is unlikely that Jim’s doctor will accommodate Jim’s request.  Being flexible does not mean sacrificing fundamental principles and sound judgement.

Penicillin production in 1944.

Here’s an anecdote from my own practice.

Patient:  I think my diverticulitis is acting up.

Whistleblower:  I agree, but it seems like a mild case.

Patient:  Better give me some antibiotics before it really takes off.

Whistleblower:  We now believe that mild cases can heal themselves without antibiotics.  There is high-quality medical evidence supporting this.  And antibiotics have real risks.  Have you ever heard of C diff?

Patient:  I’ve always had antibiotics in the past and recovered every time.  I’d be nervous to do nothing.

Whistleblower:  I understand.  Of course, in those past episodes, it may be that you would have recovered on your own without antibiotics.   How about I write you a prescription for antibiotics so it’s available to you? See how you are doing over the next 2-3 days.  If you continue to improve, as I expect, then you can simply continue to heal on your own.  If, however, there is any worsening of your condition, you can begin the antibiotics.

Patient:  I’m okay with that.   I’ll feel better knowing that the antibiotics are available if I need them.

Situations as described above are commonplace in physicians’ offices.  Remember that we physicians cannot guarantee perfect outcomes.  Our sound advice might not deliver for the patient.  It’s all about considering the risks and benefits of the reasonable options.   Imagine how much better our medical advice and life advice would be if we could peer into the future.  I’m sure that the artificial intelligence wizards are working on this right now!