Week: 488.4 Guest: Joseph Zebley, M.D. Topic: When to Go to the Doctor Host: Richard Roeder Producer: Ed Graham

NEMA: This is a discussion about deciding when to stop self treatment and go to the doctor. My guest is Dr. Joseph Zebley, Chairman of Family Medicine at the St. Joseph's Hospital in Baltimore, Maryland.

NEMA: Dr. Zebley, one of the issues that comes up more and more often these days is the cost of medical care and therefore determining when a visit to the doctor is really necessary. What are some of the considerations that need to be factored into that decision?

ZEBLEY: Many individuals have different thresholds and see the physician for different conditions. As we've discussed in the past, when an individual has a high fever, when a person seems to be developing an infectious condition, that certainly warrants a visit to a physician. Many people however suffer from long-standing chronic illnesses - hypertension, diabetes, arthritis and others, and they and their physician have to work out a schedule which they're both comfortable with and set up a time frame when to see the doctor. For example, every three to six months, let's say, for hypertension or someone with diabetes maybe should see the physician when their home blood sugars start coming out of a given range that the patient and the physician have worked out together. Someone with arthritis may have to see the doctor very frequently for monitoring of certain medications and may again have certain times to see the doctor when pain states become such that medicines aren't working. So it's a very individualized kind of question depending on the person, the doctor and the diagnosis.

NEMA: There's an old saying in medicine, I'm not sure how old, maybe you could tell me, that if you wait 72 hours the vast majority of ailments that people have would have cleared up anyway and they never would have had to go to the doctor. Do you take issue with that?

ZEBLEY: Not at all. The vast majority of colds, for example, the things that we see during the fall, winter and early spring season are very self-limited and frequently would disappear with no further intervention. And then it's the difficult position of the physician to tell someone that what they have is minor even though they may not feel that it's minor, they may feel pretty miserable and we have to refrain from prescribing antibiotics, refrain from overtreating conditions that will probably go away by themselves.

NEMA: How careful do you believe doctors should be particularly during the winter months when flus are around and colds. How careful do you believe that doctors should be about prescribing antibiotics over the telephone?

ZEBLEY: Antibiotics over the telephone is one of my pet peeves. Certainly people who have chronic conditions like emphysema or smokers or people who in the past have had serious pulmonary infections, chronic bronchitis or pneumonia, I will gladly prescribe the antibiotic over the telephone but to prescribe penicillin and ampicillin and tetracycline and erythromycin over the telephone for what is most likely a viral illness only allows the bacteria and other germs in the body to develop resistance's so that we end up having to use stronger and stronger antibiotics down the road. So generally I would request that patients be seen before an antibiotic is prescribed over the telephone.