“Doctor, I have a sinus infection and headache; my nose is also discharging greenish color- surely I need antibiotics”
I’m sure all of us physicians have come across a patient like this! They are so confident that they need antibiotics, while the reality may be the opposite. According to the Center for Disease Control (CDC), 1 out of 3 antibiotic prescriptions is unnecessary. The findings published in the Journal of the American Medical Association (JAMA) reveal that at least 30% of antibiotic drugs in the USA are not necessary.
Most of these antibiotics were prescribed by doctors' offices, and emergency departments, primarily for respiratory infections brought about by viruses. Common ailments include viral sore throats, common cold, ear infections, sinus, and bronchitis, which can’t be treated with antibiotics.
The Threat of Antibiotics Overprescribing
Antibiotic overprescribing is a problem and can cause antimicrobial resistance, allergic reactions, Clostridium Difficile infections, and increased healthcare expense. Even though the threats are recognized, physicians continue to prescribe antibiotics.
We have heard these similar complaints for too long. The issue is not with what patients ask for, and some doctors may prescribe them to benefit from the doubt. Even most of the patients are aware of this practice. They may even get antibiotics from neighboring countries where it is sold over the counter or by the recommendation of a pharmacist.
Today with easy access to information and the spread of the internet, these types of consumer-oriented comments are getting more common. Physicians need to get oriented and accept the change. But this is not the only issue, and many things are being overlooked.
Patients are increasingly placing their distrust on the healthcare system, and the problem has become glaring in the current time. It has gained traction in the last few decades with cost-saving healthcare models and the progressive utility of managed healthcare system.
We have to accept that too many antibiotics can develop bacterial resistance and hamper the treatment of bacterial infection while increasing healthcare costs. It seems that consumerism and cost-saving models conflict with each other. The problem is plaguing patients and the economy and creating a significant burden on physicians and healthcare providers.
Things from the Physician’s Perspective
We can handle the issue in some ways!
We can agree with our patients and write down the names of antibiotics even though we are skeptical about their appropriateness- but that will be going against the standards of medical practice. Some of us may justify the move as no direct harm is caused, and also, confirmation tests may not be possible under present circumstances. Prescribing it in HMO settings may earn him a negative review from the organization and leave his clinical judgment and decision open to questioning.
We can try to educate and make the patient aware that his condition doesn’t warrant antibiotics. But in HMO settings, physicians seldom get the time to discuss the matter, which is of great importance. We can stop prescribing antibiotics, but that may earn a negative review from the patient as no explanation is provided.
Things from the Patient’s Perspective
The issue hovers on trust and health for the patient. Patients generally trust their doctors and comply with their recommendations. Even in a consumer-driven market, they go for physicians they trust and develop a strong relationship. Such a bond is necessary for the quality of care and two-way participation and compliance. But in the present system ridden with mandates, this bond is lacking as doctors and patients are not matched by choice. For this reason, the time and resources required to build up the understanding are exceptionally high. Also, physicians cannot afford to live with an unhappy patient and experienced a considerable burden of proof.
Patients are researching more these days with easy access to information, but they are not adept enough to always make the right decision. They will be overtaken by pharmaceutical ads that tell them to ask their doctors if the medication is right for them.
It’s not the Fault of the Physician.
The issue makes it look like the physicians are to be blamed, but it is not the case. This seems to be a multidimensional system failure, with efforts to separate the physician and the patient. The signs point to corporate greed and bureaucracy made worse by physician passivity and our inability to address the root causes.
Any clinic visit is a personal matter between the doctor and the patient but is interrupted by external factors such as government mandates, lobbying of pharmaceutical companies, and the insurance industry. The equilateral triangle of quality, cost, and time will not stay equilateral for a long time. Managed care (HMO) has failed, we haven’t utilized technology, and even accountable care organizations have been unable.
We have to put healthcare back in the hands of people where it belongs- individuals, patients, and doctors. Technology has to be matched with the right strategy, and we need to educate ourselves so that we can ask more questions. Time has come to include knowledge of healthcare technology in the medical school curriculum and make health information interoperable by decentralizing it.
We need to be able to spend enough time with a patient to explain our decisions and clinical judgments and make them comfortable with them. Just asking doctors to stop prescribing antibiotics and patients to stop taking them will not suffice.