2 viral infections, 2 different outcomes

In the course of 3 days (last month), I saw 2 patients that presented with the exact same viral illness.

Mild sore throat, fatigue, subjective fevers, dry cough.

In both patients I suspected a viral infection that didn't require an antibiotic.
That's where the similarities ended.

Patient A was a 60+ year old male with a few stable medical problems who regularly came to our resident clinic. I saw him with our residents a few times before. She stated she get's this once a year and antibiotics always resolved it. When I suggested just symptomatic treatment and time, the visit turned sour. His wife who was also in the room, questioned the entire visit, suggesting I was making him suffer. The wife's doctor (from a different office) had already started her on antibiotics for a similar illness. It was a Friday and I promised I would call him Monday to reassess symptoms.

I called Monday, and  he said he was feeling a bit better, but had already gone to an urgent care center Sunday and received antibiotics.

"Sigh." I thought.

Patient B was a 50 year old male, and presented with essentially the same illness. I gave the same viral illness speech and offered the same follow-up call.

"you got it Doc!" 
And with a smile, he was off.

The difference?

Patient B 2 years prior, walked into our office with 3rd degree heart block.
 He credits us (and his cardiologists!) for saving his life that day.

A patient requesting antibiotics for a viral illness is a common event in primary care and can cause quite a bit of "agita" 

 I also know how hard it can be to say no to a patient.
I also know how in primary care, the amount of time we get with a patient really limits proper counseling.

Ultimately, it's a trust issue. Trust between a patient and primary care physician is a core principle that takes time to develop. I don't always have the luxury of rescuing a patient from the jaws of death and getting instant credibility. It takes a lot of time, effort, patience and counseling to develop a trustworthy relationship.

Unfortunately, in modern medicine, many elements undermine that trust. Until primary care physicians are given the opportunity and incentive to do what it takes to that build trust, our healthcare system will continue to erode and free fall further into the abyss.