I will not be giving out the Over the Counter Drugs handout provided by the BCMA after reading its advice on productive coughs. This handout repeats the old wives’ tale that yellow or green mucus is a reason to contact your doctor. While there is no doubt that blood in mucus is a reason to consult your doctor, yellow and green mucus is often quite normal as most of us have experienced this with viral infections. Colored mucus is especially common in the many patients prone to asthma reactions with viral infections (with many of these patients being incorrectly diagnosed as having bronchitis and given antibiotics). There are other valid reasons to consult a doctor with a cough, but isolated colored mucus, provided that it does not persist for too long (I tend to suggest that a week or so is normal), is not one of them.
The statistics regarding prescription of antibiotics are horrendous, with some studies showing that 50% or more of patients who clearly have viral infections end up being given antibiotics by doctors. I have patients coming into the office over and over telling me that they need antibiotics for their colored mucus despite having no other signs of anything but a viral infection. It becomes a challenge to convince them otherwise when they have been told this by various doctors over the years.
The perpetration of this old wives’ tale about colored mucus is clearly one of the big reasons that antibiotics are being overused and that antibiotic resistance is increasing to dangerous levels. In addition, we are spending vast amounts of money treating these non-illnesses when patients with real problems, such as those in hospital and those needing joint replacement surgery, are not being treated adequately due to lack of sufficient funding and resources.
—Doug McFee, MD
I appreciate the opportunity to address Dr McFee’s concerns about the BCMA pamphlet Over the Counter Drugs. Certainly we do not want to encourage the over-prescribing of antibiotics, but I am confident that physicians are entirely aware of those concerns and do prescribe appropriately. This series of pamphlets is very popular with our patients, but it is very important that patients are advised when they should consider seeking help from their physicians and not to discourage them if there is a possibility of more serious disease. In this case, the advice given is to allow the physician to treat the patient according to best medical practice—which may or may not include antibiotics. The physician is in the best position to make that decision according to his or her clinical judgment.
—Michael Golbey, MD
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