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Stewardship of Health Care Resources: Responding to a Patient’s Request for Antibiotics

  • Authors: Case History by Daniel P. Sulmasy, MD, PhD; Michele Mathes, JD and Lois Snyder, JD; Commentary by Jon C. Tilburt, MD; Michele Mathes, JD and Lois Snyder, JD
  • CME Released: 11/5/2012; Reviewed and Renewed: 12/29/2014
  • Valid for credit through: 12/29/2015, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for all clinicians who care for patients.

The goal of this activity is to evaluate ethical and practical issues of stewardship of healthcare resources.

Upon completion of this activity, participants will be able to:

  1. Distinguish the primary ethical commitment of physicians in patient care.
  2. Analyze the ethical response to patients’ requests for inappropriate treatment.
  3. Evaluate the issue of economics in the ethically appropriate distribution of treatment.
  4. Develop an ethically and clinically sound response to inappropriate treatment requests from patients.


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  • Jon C. Tilburt, MD

    Mayo Clinic, Rochester, Minnesota


    Disclosure: Jon C. Tilburt, MD, has disclosed no relevant financial relationships.

  • Lois Snyder, JD

    Director, Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania


    Disclosure: Lois Snyder, JD, has disclosed no relevant financial relationships.

  • Michele Mathes, JD

    Senior Associate, Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania


    Disclosure: Michele Mathes, JD, has disclosed no relevant financial relationships.

  • Daniel P. Sulmasy, MD, PhD

    Kilbride-Clinton Professor of Medicine and Ethics, The Department of Medicine and Divinity School; Associate Director, The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois


    Disclosure: Daniel P. Sulmasy, MD, PhD, has disclosed the following relevant financial relationships:
    Served as a consultant for Pfizer Foundation Medical Academic Partnerships Program helping to select applicants for their bioethics fellowship 2010-2012


  • Lois Snyder, JD

    Director, Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania


    Disclosure: Lois Snyder, JD, has disclosed no relevant financial relationships

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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    For Physicians

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    The cases and commentary were developed by the American College of Physicians.

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Stewardship of Health Care Resources: Responding to a Patient’s Request for Antibiotics: Case History


Case History

Ms. Carr, a junior member of the medical center's administrative staff, presents to the urgent care center with a 3-day history of sore throat, cough, congestion, and sneezing. She says she feels feverish and that she thinks her glands are swollen, but she does not know her temperature. She is 27 years old, has no significant medical history, and no known drug allergies. She does not work with young children and has no children of her own. On examination, her temperature is 37.8°C, her pulse is 80 beats/min, and her respiratory rate is 12 breaths/min. She has no rash. Her pharynx is erythematous, and there is a single 2-mm patch of exudate on her right tonsil. Her ears are normal. She has shotty posterior cervical adenopathy (not present anteriorly), and her lungs are clear. The office where she is being seen does not have rapid streptococcal (strep) testing available.

Ms. Carr is supposed to board an airplane in less than 24 hours for 3 days of fundraising in another city. Seeing her today is Dr. Trainer. “Good news, Ms. Carr,” says Dr. Trainer. “Looks like you most likely just have a viral upper respiratory infection.” Dr. Trainer expresses concern about her ears during air travel and advises that if she must fly, she should still try to get plenty of rest; drink lots of fluids; take acetaminophen, aspirin, or a nonsteroidal antiinflammatory drug for discomfort; and use an over-the-counter nasal decongestant as required for symptoms of congestion and prophylactically before her flight. Ms. Carr responds, “I must fly. But I’m worried about strep throat. My last doctor always gave me antibiotics when I had a sore throat." Dr. Trainer explains that it is very unlikely that she has strep throat by clinically validated criteria and that antibiotics are ineffective to treat a viral infection. She is nonetheless insistent on leaving with a prescription for antibiotics, asking, "Aren't you concerned about my ears like you said? And I'm going to be out of town in back-to-back meetings. How will I get antibiotics if I get sicker?"

Table of Contents

  1. Introduction
  2. Case History
  3. Commentary
  • Print