Posted by: notdeaddinosaur | February 22, 2014

Saving Lives with Primary Care, Part 1

I’m going to let you in on a little secret: not all doctors “save lives” every time they see a patient. Emergency medicine physicians,  trauma surgeons, oncologists can all rightfully brag about “saving lives.” Hell, even paramedics probably save more lives than I do over the course of a year. I admit it: more of my time is spent either relieving suffering (diagnosing and treating acute but self-limiting illnesses) or trying to prevent it down the road. Trust me: it doesn’t feel the least bit heroic to discuss diabetic diets, recommend weight loss, prescribe blood pressure medicines, and advise people to quit smoking over and over again, day in and day out.

Also, because primary care is an ongoing endeavor, there will always come a time when “saving a life” is not the goal. Helping patients with terminal conditions to remain comfortable — physcially, emotionally, and spiritutally — through the last stages of their lives is an important facet of our job. It just doesn’t make for compelling cocktail party conversation or blog fodder.

But I still have my moments.

A patient* came in for followup after a protracted hospitalization for sepsis, weak but well on the road to recovery.

“You saved my life, Dr. Dino.”

Those were her exact words.

She said it again: “You saved my life.”

Do tell.

“I give you credit: all those times I came in asking for antibiotics that you wouldn’t give them to me. If you had, I would have died.”

She was quite sure of it.

Who was I to argue?

She was probably right. If I had given in and prescribed antibiotics for previous conditions when they were clearly not needed, I would have killed off the susceptible portion of her microbiome and allowed the smaller population of resistant organisms to prevail. Had those resistant bacteria been the ones to invade her blood stream, she very likely would have succumbed.

We doctors may have “The power of the prescription pad.” But there are still plenty of times when we just need the power of “No.”

*Blogged not just with permission, but by request. h/t TC



  1. Lost a friend last year to a resistant C-diff infection after she had been on antibiotics for 2 months. Don’t know what her doctors were thinking…

  2. There are some Salmonella serovars that become deadly if you _do_ give antibiotics [the treatment triggers a toxin release]…

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