My pager went off just after supper. The caller was Cindy Spofford, who works in a local real estate office, the patient was her four-year-old daughter Amanda, and the number was a cell phone. Their regular physician is Dr. Wilford Brown.
“Hi Doctor, thanks for calling me back. We’re down in the Capital City visiting my parents for Christmas. Amanda has had this terrible cough for two days and we just took her to the emergency room. They diagnosed her with bronchitis but didn’t give her an antibiotic. We wanted to check with you if that makes any sense.”
I inquired about her general condition. She didn’t have a high fever, had no trouble breathing, was eating and drinking fine, didn’t have any history of asthma, and her cough was dry and almost barking; I could hear her in the background, coughing in the back seat.
“Well, bronchitis is usually viral”, I explained. “Doctors have been quick to prescribe antibiotics for bronchitis for many years, but most of the time, they’re not necessary. Even ear infections are often caused by viruses, and can go away without antibiotics. You probably know how much trouble we’re having now with drug-resistant staph infections, right? They are such a problem because of all the antibiotics we have used unnecessarily over the years.”
I made sure that Amanda had had a decent physical exam and reviewed the warning signs that would warrant a return trip to the emergency room down in the Capital City.
Cindy thanked me. I wished her family a Merry Christmas and mused over how a reassuring voice on a cell phone from your hometown sometimes rates higher than an in-person opinion from a big city emergency room doctor.
A Country Doctor Writes: 
It’s always nice to hear that our opinion is still valued. It again speaks to the power and potential that continuity of care holds. Good for that ER doc that didn’t take the easy route and just write an antibiotic as well.