Actually, one of the biggest problems with the modern practice of medicine as I see it, is that MDs regardless of training, don't really fixate on either diagnosis or treatment - they fixate on how to please the patient in front of them.

And by "please" I mean they want to satisfy the patient well enough to avoid any unpleasantness, and do it quickly enough that they can see the next patient.

Telling the patient that you don't think he needs antibiotics for that viral infection accomplishes neither of these things. Most patients are going to be pissed off, and no doctor likes pissing off his patients.

It is also a truism among doctors that explaining to a patient why he doesn't need antibiotics takes much longer than just writing the prescription for antibiotics in the first place.

Intellectually, most people know that doctors over-prescribe lots of medications including antibiotics, but I can tell you from years of experience that it's a rare patient that shows up in the doctor's office with a viral infection who isn't a lot happier to leave with a prescription for pills that will help "clear it up".

I think you paint with too broad a brush, my friend.

While it is true that there are a number of patients who will only be happy if we write them a prescription for antibiotics, it has been my experience (and this is validated by research) that the majority of patients will appreciate the difference between viral and bacterial infections and will understand that antibiotics will do them no good while expose them to some risk of harm if the physician respectfully explains these issues to them. Would they be happier if I offered them a pill that will take all their symptoms away? Of course--but there is not such pill. Do they go out frustrated that with all our research we still don't have a cure for the common cold? Of course--but a smart physician does not confuse that frustration with a patient being truly "pissed off".

In a good number of cases, the patients really don't want to take medications, especially antibiotics, and are relieved when I tell them that they are not going to help!

Now, I will admit that some patients do end up "pissed off" no matter how clearly and carefully I explain the above issues, and no matter how sympathetic I am toward their suffering and no matter what non-antibiotic treatments I suggest that can help them with their symptoms. I have had patients actually scream at me demanding antibiotics. That does not get them the antibiotics, and I guess in the end they eventually go to find some other physician who is less careful in protecting their health. But this is a very small minority of patients, in my experience. Some patients are a bit insistant, but nowadays, all I have to say is "drug-resistant bacteria" or "MRSA" and they realize the significant downside of unnecessary antibiotics.

Yes, we want to "satisfy" the patient. But a sensible physician will realize that you can't please all the people all the time, and that above all we have to do what is in the patient's best interest. A "pissed off" patient is always better off than one who is harmed or killed by unnecessary treatment.

Rx for viral symptoms in a child - honey. What kind of honey? Buckwheat honey. What does Buckwheat honey have that could have medicinal properties? Quercetin. Look up Quercetin in pubmed and what do you get? ~6,000 articles for you to read and contemplate per what this great cardiologist author wants every physician to do with every intervention contemplated in an office setting.

This is an actual conversation I had with a family member a few years back. The patient is a mid-40 year old woman with a history of chronic diarrhea (unknown etiology) who came on an emergent basis to see me with a viral URI. I examined her and took a throat culture. I had a lengthy conversation with her about the usual stuff, how this was likely a virus and would go away on it's own, and how with her chronic GI condition, unnecessary antibiotics were the last thing she needed. She leaves the office, and about an hour later I get a call from her husband who's yelling at me, at the top of his lungs, "WHY DIDN"T YOU GIVE MY WIFE ANTIBIOTICS???!!!!" I replied more or less, the same thing that I told the patient in the office. His response: "BUT A PERSON COMES TO THE DOCTOR TO GET ANTIBIOTICS!!!".

As i've said, you've got to be out of your mind to become a doctor these days, particularly a primary care 'provider'.

Doctors are trying to "please the patient"? You should tell that to some of the unbelieveable bullies Ive been to who lauged at anything I tried to say other than "My symptoms are X, X, and X." Everyone keeps saying to be an educated patient. When you've got a doctor with a god complex who says "Im the doctor, and Ill be the one to figure out what you have" every time you try to offer some helpful ideas, its awful hard to figure out -Do you want us to walk in and just give a list of symptoms and shut the hell up or do you want to know our symptoms and what our best (un)educated guess is so you have something to go from?