I have a unique question, concerning a potentially "mild" violation


Q: I have a unique question, concerning a potentially "mild" violation of a doctor's Hippocratic Oath.

My In-Laws just had a number of people over at their house for the Easter weekend- including several of which who, as it turns out, had strep-throat.

On Monday afternoon, my 13 year old brother-in-law came down with a sore throat. Normally, my mother-in-law would wait a day or two to see if his symptoms worsened, but he was scheduled to leave Wednesday on a 3 day class trip to Washington D.C. She took him in to the doctor, but his regular pediatric physician was unable to see them on such short notice, so they were seen by one of his associates instead.

The doctor performed a RST and took a culture. The RST was negative, which wasn't surprising as my brother-in-law has had strep twice before and both times the RST was negative as well. The doctor (who, according to my mother-in-law, seemed very annoyed at having to work them into her schedule) heavily advised my mother-in-law to wait on the culture and come back in only if his symptoms worsened.

However, given his prior negative RSTs and his planned departure to D.C. in just over 48 hours, my mother-in-law asked that my brother-in-law be prescribed an antibiotic regimen. The doctor seemed to grow even more irritated and informed my mother-in-law that some people experience gastrointestinal distress while on antibiotics and asked if she wanted to be responsible for him feeling sick. My mother-in-law was a little taken aback by the doctor's demeanor, but she insisted that she wanted some antibiotics to be prescribed. Finally, the doctor curtly wrote out a prescription and the appointment ended.

My mother-in-law was able to get the prescription for Amoxicillin (two rounds of 875mg a day) filled, and he began the regimen that evening. He throat was a little worse the next day, but other than that, he felt fine. However, on Wednesday (the day of his departure to D.C.) he reported mild gastrointestinal pain. He still wanted to go, so he embarked with his class later that evening. But when we called him early Thursday, he told us that his gastrointestinal pain was now intense, and that he had been experiencing severe diarrhea as well.

His mother was fairly shocked, as he had never experienced such a reaction to Amoxicillin in either of his two previous times that he was prescribed it. Upon being informed of this, my wife looked up common Amoxicillin dosages and discovered that my brother-in-law was prescribed a very high dose, reserved for adults with fairly severe cases of strep (to put it in perspective, the average dose recommendations for him 3 months ago when he was 12 would have been approximately 20x less). Now, while my 13 year old brother in law, who is fairly tall but very thin and weighs only 113lbs, should not, in our opinion, been prescribed such a high dose (two of the parent chaperones on the trip, one a doctor and one a pharmacist, both agreed that 1750mg a day of amoxicillin is way to much for a kid of his age and weight), we would normally, we would have given the doctor the benefit of the doubt- or at least would have written the discrepancy off to incompetence.

However, given the doctor's demeanor and eerily prophetic (despite his two previous benign encounters with Amoxicillin) warning, we are wondering if the doctor didn't intentionally prescribe a high dosage with the intention of giving my brother-in-law gastrointestinal distress... all to "teach" my mother-in-law a lesson.

So, my question is, what is your opinion- are we on to something or are we overreacting over nothing? And if you think we are right, what should our course of action be (e.g. requesting that that particular doctor should not be allowed to treat my brother-in-law anymore)?

Side note: we understand that antibiotics are not a magical "cure-all" pill, and we realize the risks inherent with them being prescribed unnecessarily. However, in our judgement, which is based partly upon our past experience with strep, they were a necessary prescription in this instance.

And, as of today, my sister-in-law's fiancee (who was there for the Easter weekend festivities) has come down with a serious case of strep himself.


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