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CME

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
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • 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.


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Jon C. Tilburt, MD

    Mayo Clinic, Rochester, Minnesota

    Disclosures

    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

    Disclosures

    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

    Disclosures

    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

    Disclosures

    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

Editor

  • Lois Snyder, JD

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

    Disclosures

    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

    Disclosures

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

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC

    Disclosures

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


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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

    Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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  1. Read the target audience, learning objectives, and author disclosures.
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CME

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

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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