2nd patient asking me for "allergy shot"?

[doctor-mom]

Hi fellow internist,
I've had a 2nd new patient come to me asking me for "steroid shot" for allergy. I've never given either oral steroids or injections for seasonal (or other) allergies. I could not find any indication of anything along those lines on uptodate either.
Are the local drs just giving it in the community giving this without proper indications or am I missing something?
much thanks!

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[VA Hopeful Dr]

Hi fellow internist,
I've had a 2nd new patient come to me asking me for "steroid shot" for allergy. I've never given either oral steroids or injections for seasonal (or other) allergies. I could not find any indication of anything along those lines on uptodate either.
Are the local drs just giving it in the community giving this without proper indications or am I missing something?
much thanks!

Yes, older docs are notorious for doing this. Patients feel better when they get a steroid shot, pretty much no matter what's wrong with them.

There is no evidence behind the practice. Stay strong, don't do it.

 

[USCguy]

Drmom,

How long have you been in practice? I remember my first patient coming in for viral URI asking for a "snot shot" and I was bewildered because I had never heard such a request in the academic medical practice I spent residency.

It seems to be some variation of steroid and ceftriaxone for cold and flu symptoms; probably just depomedrol or kenalog for allergies.

I see why they do this...someone along the way gave them steroids for a URI (slight variation of your SAR) and they felt better within hours, so to the patients, why not ask for the same thing?

Full disclosure: In all honesty, I got to the point where if I can get in and out of the room with no antibiotics by giving a few days of prednisone, I just do it. If all they get is "OTC, rest, salt water" you can bet the local UC will be happy to pass them a Z pack about an hour later. Not saying it's right, but it's my reality. I always say "it's viral, so the antibiotics are just gonna give you diarrhea without making you feel any better. So while this isn't a cure, it will make it easier to deal with the next few days..." obviously this is a no-go in diabetics.

 

[VA Hopeful Dr]

Drmom,

How long have you been in practice? I remember my first patient coming in for viral URI asking for a "snot shot" and I was bewildered because I had never heard such a request in the academic medical practice I spent residency.

It seems to be some variation of steroid and ceftriaxone for cold and flu symptoms; probably just depomedrol or kenalog for allergies.

I see why they do this...someone along the way gave them steroids for a URI (slight variation of your SAR) and they felt better within hours, so to the patients, why not ask for the same thing?

Full disclosure: In all honesty, I got to the point where if I can get in and out of the room with no antibiotics by giving a few days of prednisone, I just do it. If all they get is "OTC, rest, salt water" you can bet the local UC will be happy to pass them a Z pack about an hour later. Not saying it's right, but it's my reality. I always say "it's viral, so the antibiotics are just gonna give you diarrhea without making you feel any better. So while this isn't a cure, it will make it easier to deal with the next few days..." obviously this is a no-go in diabetics.

I'll do 3 days of decadron for bad sore throat. Otherwise, most patients are surprisingly OK with non-prescription treatment if you talk it over with them, give them specific OTCs to try, and have a date where if they aren't better then they call you for a new plan.

 

[DNM]

This may not necessarily be a steroid shot. Allergists fairly commonly give immunotherapy injections for persistent allergy with a known allergen (i.e. dog). I imagine they should be seeing an allergist if this is what they're after.

 

[chessknt]

I refer people who fail aggressive rhinitis care to allergists for immunotherapy consideration if the person is interested. It has approximately the same efficacy as daily intranasal steroids so I always have them do that first unless there is some kinf of contraindication.

 

[VA Hopeful Dr]

This may not necessarily be a steroid shot. Allergists fairly commonly give immunotherapy injections for persistent allergy with a known allergen (i.e. dog). I imagine they should be seeing an allergist if this is what they're after.

Except the patient specifically asked for a steroid shot...

 

[jdh71]

How much can I bill for said magical injection though. This is a question I am interested in for science.

 

[PlutoBoy]

How much can I bill for said magical injection though. This is a question I am interested in for science.

Physician Fee Schedule Search

 

[flasheroonie]

This sounds ridiculous


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