Blue Care Network Best Practices

Pharyngitis

Ann Arbor pediatrician makes strep testing part of practice’s culture

Andrew Seiler, M.D.

Physicians are paying closer attention to the inappropriate use of antibiotics, and some have established strict office procedures that must be followed before prescribing these drugs.

Liberty Pediatrics in Ann Arbor requires strep testing for children who have symptoms of pharyngitis. “We all feel that it’s important to not give an antibiotic,” Andrew Seiler, M.D., said of himself and his two partners. “When we started working together it was one of the questions we asked each other,” he said. The practice has been seeing patients for 11 years.

The doctors discuss the risks of antibiotics and make the topic part of its monthly staff meetings. Even though they have eliminated offering a prescription for antibiotics by phone, “I still think it’s important to talk about it and keep our doctors feeling like it’s worthwhile,” says Dr. Seiler. The policy is consistent throughout the office, including after‑hours staff.

The doctors do a rapid strep test when children complain of symptoms. The rapid strep is followed up by a culture, which takes a few days for results. No antibiotics are prescribed until the culture comes back because the rapid strep can show a false negative, Dr. Seiler explains.

Andrew Seiler, M.D., and six-year-old Theron Brooker-Nolan.

Patients are also used to the idea that antibiotics are never prescribed over the phone. The doctors first bring up the topic with parents at the initial meeting so they are aware of the practice’s rules.

Most of the time children with pharyngitis don’t need the antibiotic, explains Dr. Seiler. Right from the time the parents first call the office, they can discuss symptoms with a nurse and can be persuaded to wait the extra day or two until the culture comes back.

“People often feel like they want to do something to help the child’s symptoms,” says Dr. Seiler. “So we teach them how to care for children with colds without giving them a prescription and it makes the parents feel better too.”

To keep same-day appointment slots open for sick children, Dr. Seiler and the other two doctors at the practice schedule fewer checkups during the winter. “It gives us the opportunity to spend more time with our patients,” Dr. Seiler says.

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