You are evaluating a 54-year-old woman who recently moved to your community from out of state. The patient found your name through an Internet search. Her chief complaint is right ear pain of three months’ duration, which she believes is an “ear infection.” She is requesting antibiotics for the alleged infection, which she claims is preventing her from sleeping at night due to the pain. Her past medical history is significant for type II diabetes, hypothyroidism, and elevated triglycerides, as well as two motor vehicle accidents in the past, for which she wore a cervical collar for pain. The patient states she is a non-smoker and non-drinker, and denies drug use. Current medications include levothyroxine, metformin, and rovustatin.
Explore this issue:December 2018
The complete head and neck examination, including microscopic otoscopy and flexible fiberoptic nasopharyngolaryngoscopy, are within normal limits, save for some discomfort when palpating the posterior neck. Dental occlusion is Class I, and there is no crepitus or pain at the temporal-mandibular joint. Your working diagnosis is cervicalgia as a result of previous trauma, with referred pain to the ear. As you explain your findings and presumptive diagnosis to the patient, she quickly reiterates that she feels her pain is due to an ear infection, and what she really needs is an antibiotic, and by the way, could you refill her thyroid, diabetic, and statin medications since she has been without them for the past three weeks due to her move to this community. She states, “I can’t live with this infection, and without my medications.” Additionally, she mentions that she came to see you because you had excellent patient satisfaction scores on the Internet.
How should you deal with her requests?