Shotgun Medicine




"Shotgun medicine" is a descriptive term referring to a common practice of medical treatment used by doctors in many different settings. The basic idea is to "blast" everything, like firing a shotgun towards a suspected danger, in the hopes that you will kill whatever might be the cause of the danger. Unfortunately, you sometimes end up killing a friend or an innocent bystander.

Most shotgun medicine involves using excessive treatments for possible illnesses when there is no evidence that those illnesses are even present. An example would be a doctor who treats someone with an antibiotic because she has a sore throat, but the doctor does not check to see if it is strep. In most cases it would not be strep, so the antibiotic is likely to be of no help and could cause great harm if there were an allergic reaction, side effect of the medicine, or if it caused the development of resistant bacteria.

Why do doctors practice "shotgun medicine"?

Some doctors feel forced to practice this way in order to please demanding patients, because of demanding insurance companies, or because they feel insecure about their ability to make the correct diagnosis. They may not feel very strongly about their medical oath to "first do no harm" to the patient.

Doctors are trained to follow the principle of "First do no harm".

Others might have been trained in institutions which are more research-oriented, and are used to over-treating with experimental drugs or treatments. Still others might have trained many years ago, before evidence-based medicine had come to light. Some doctors might just be trained poorly, or graduated near the bottom of the class, and never learned the proper way to diagnose and treat illnesses with the least amount of harm to the patient. (Remember, statistically half of all doctors are below average…..and half are above average.)

Why is there so much "shotgun medicine" in the ER?

Doctors working in Emergency Rooms and Urgent Care Centers work under unusual circumstances. They are not sure if they will ever see the patient again after this encounter. They do not know how reliable a patient will be about following instructions or taking medications. Plus, they are working in extremely demanding conditions, with very large work loads, and the pressure of true life-and-death emergencies coming in to interrupt their care of your sick child.

Many hospitals throughout the USA are trying to expand the services of their ER’s to encourage care of minor problems. This is a money-making venture for the hospital, but puts even more demands on the doctors working there. Consequently, even the best and most conscientious ER doctors are forced to practice shotgun medicine just to get through their heavy workloads.

What are the signs of shotgun medicine?

What seems like obvious shotgun medicine to me, might be difficult to spot by a non-medically trained person. I’ll see if I can put this in a style similar to Jeff Foxworthy:

If medications are prescribed without an adequate explanation as to the purpose of those medicines, ……YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If antibiotics are prescribed for illnesses that are caused by viruses, such as colds, bronchitis, sore throat not caused by strep, RSV infections, chicken pox, stomach virus, sinusitis (less than 2 weeks duration), or any disease with the word "virus" in it, …… YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If the doctor prescribes medications without ever examining your child, …….YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If the doctor prescribes oral antibiotics over the phone (without seeing your child), …….YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If you notice a pattern of getting hundreds of dollars of lab tests on every visit, then being treated with the same antibiotic every time, …….YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If the doctor orders many lab tests, but you don’t understand the purpose of most of the tests, …….YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

What can patients do to avoid shotgun medicine?

Number one, NEVER go to the Emergency Room or Urgent Care Center unless it is a true emergency. If your child needs stitches, has a bad earache, has signs of appendicitis, has a fever of 106, or even an asthma attack, you still have plenty of time to call your pediatrician. Chances are that your pediatrician can see you in less than half the time you would have waited in the waiting room of the ER. Sometimes your pediatrician will direct you to the ER when that is appropriate.

Sometimes you will see pediatricians or other doctors who practice shotgun medicine. Watch for the signs of shotgun medicine, and if you suspect that, get a second opinion! Make sure you ask your doctor the reasons for any tests or treatments that seem excessive or that don’t make sense to you.

See if your doctor seems to understand the principles of evidence-based medicine (many of them don’t!). He or she should be able to explain why they ordered a certain medication, versus a different one or none at all. "No medicine" is best if possible, since any medicine could potentially cause harm.

Don’t be a victim of shotgun medicine!