Cough Syrup

One of the things we struggle with upon occasion is the idea that patients expect to receive something when the come into the clinic--basically, they expect medicine even when they do not need it. This doesn't happen much, because most of the kids we see are genuinely pretty ill, but we see our share of common colds, too. Now the desire to leave the clinic with something in hand is not the most absurd of ideas. I think patients do it at home, too, expecting a prescription to make the visit worth it. Every provider has her own way to deal with this issue. I have decided that this is the purpose of the cough syrup at the clinic. It's not an antitussive, but rather we have 3 different liquid formulations of expectorants. The families become accustomed to receiving a bottle each time the child is sick with even the slightest and driest of coughs. This has become the culture at the clinic (and perhaps in the greater area).

Lately there have been a few occasions when I have sent the family home with a bottle of tylenol for fever, and instructions that the child's cold should pass in a week or so, and warning signs for a more serious illness. As they are leaving, I've heard something like "Excuse me, you didn't give me anything for his cough." Even when I explain that an expectorant does nothing for an occasional dry cough, they insist. I go back and forth about what to do in these situations. Is it a belief that the syrup will truly cure a cough? Or does it just feel better to go home with SOMETHING in these visits? And what happens when they already have something, but still want something specifically for the cough?

I was pleased to see that the mom of one of my patients today seems to have caught on that guayacolate doesn't do much to get rid of a cough. But she's been the first one to admit this to me. Some moms smile and nod, and seem to accept my explanation as to why I am the only one who won't give them the stuff. But many outright disagree, because every other doc here gives it out like candy whenever there's a cough.

This comes in light of learning that because of certain budget restrictions, we are short on important supplies (like vitamins for malnourished children). I look at the wasted expectorants, and wonder why we're really spending all that money on something that doesn't do much anyway. There's a time and a place for expectorants, certainly, but is this it?

But despite the preference for prescribing expectorants, I'm going to take matters into my own hands for my last couple of weeks here, and I think I'm going to start giving out bars of soap to these kids instead...