The Story:
A woman in her fifties called complaining of sore throat, fever (101), with no other respiratory symptoms.  Due to distance, I advised her to go to a local clinic to get tested for Strep throat.  At the clinic, the doctor took one look at her throat and, without testing for Strep, diagnosed Streptococcal pharyngitis and gave her an expensive antibiotic (a cephalosporin) to be taken for one week.  The woman called back to say that she was treated without being tested and so I asked her to come in after hours.  Her throat was red without visible pus and her office Strep test was negative.  A throat culture was done and antibiotics were withheld.  By the time her throat culture was reported negative, her sore throat and fever had resolved without treatment.

The Messages:
a) A Strep throat is not a clinical diagnosis.  It a serious infection that should be accurately diagnosed because it can cause kidney or heart damage and may also cause inter-family epidemics that can have serious long-term consequences.  It should be treated for ten days, not seven, and all close family contacts should be tested and also treated if found to be carriers.  Diagnosing it clinically and ignoring family contacts is contrary to scientific evidence and so is treating the patient for seven, instead of ten days with a non-penicillin antibiotic, and without confirmation of the streptococcal infection by proper lab tests.
b) Oklahoma is ranked highest in inappropriate antibiotic prescribing and also in bacterial resistance, a direct result of antibiotic overuse.