‘Tis the season for unnecessary antibiotics, and doing nothing!
A recent study reports that over 50% of antibiotics prescribed in the primary care setting are unnecessary.
Thats a lot of antibiotics.
How can this happen? Or better yet, how can we make sure this doesn’t happen?
The concerns about antibiotic overuse have been around since early in my career, but it seems like antibiotic seeking/prescribing have not changed much. For the record, the most commonly prescribed antibiotic is azithromycin, the antibiotic in the beloved “Z Pack.”
Just this week, three people have exclaimed to me that they are going to the doctor, they have had a nasty cold for two weeks, and they are sick of it. One of the people who had a doctors appointment for her cold symptoms asked me what I thought. Never ask me what I think if you don’t really want to know! I suggested she think about what exactly she wanted from the doctor, and that she tell them at her appointment. This was met by silence, and a questioning glare.
Here is what I think, or should I say, here is what I know: colds are caused by viruses. Antibiotics do not kill viruses. Most of us have a functioning immune system that is designed to fight (and beat) viruses and bacteria. It is not unusual for a cough to last several weeks after a cold. Antibiotics are overused and there are real, serious problems from the over use of them. Consumers want “something,” so doctors want to provide “something.”
And there in lies one cause of the over prescribing of antibiotics. Physicians and other providers are pushed hard to “keep the customer satisfied.” I know, it often doesn’t seem that way, but, it’s true. In the case of a virus or some other condition with no specific treatment, you end up sending someone home with “nothing.” “Nothing*” usually consists of a professional evaluation and assessment (utilizing years of study and experience), a diagnosis of a virus or some other untreatable condition, information, education and reassurance. This “nothing” leads to patient dissatisfaction, and the dreaded low “Press-Ganey” scores (when you say not nice things on that ridiculously long survey they send to you right about the time you get the bill for the “nothing” you received). So, instead of “nothing,” paraphrasing Mick Jagger, sometimes you get what you want, which for many people is an antibiotic, sometimes you get what you need, the more difficult, and I believe, more valuable, “nothing.”
Colds, the common one, are one of the top causes of clinic and Emergency Department visits. People come in and want “something.” We don’t really have anything. Symptomatic treatment with over the counter medications is about all there is…and it is not very satisfying. You can see the conflict. We have nothing much to offer. Since people aren’t happy with nothing, and some times are VERY unhappy with nothing…doctors have taken to giving them something, which often ends up being a antibiotic prescription. I am not saying its right, or even a good excuse, I am just saying how it is.
This is then interpreted as meaning “I needed an antibiotic,” and then the next time the same symptoms come, people think the need an antibiotic because “last time they gave me an antibiotic.” And the vicious cycle is formed, and perpetuated.
The problems with antibiotics are real. The scariest one I think, is the “super bugs.” when I first started medicine, we had never even heard of “MRSA” (methicillin resistant staph aureus). Now, it is something I have to consider pretty much everyday. It is a huge problem. “C-diff,” (clostridium difficile) same thing. Not a problem twenty years ago, now a daily issue. This list goes on. These problems are in addition to the “usual” problems of allergic reaction, which can be severe and sometimes fatal; and the more run of the mill problems like what I call “gut rot,” nausea, vomiting, diarrhea and yeast infections. All of this in addition to cost.
I know colds are no fun. When I get a cold I cough, a lot. I cough every time I talk, a real handicap for me!! I cough for weeks. I have a cold right now that I would do ALMOST anything to get rid of, (I am even trying to get extra sleep)…except take antibiotics!
When you make the appointment, think about what you need, and want. If it is reassurance, say that. My suggestion is to avoid antibiotics unless they are REALLY necessary, which is much less often than you think. To avoid unnecessary antibiotics, I think (I know) that you, the consumer has to lead the way. You have to give your doctor (or other provider, who, according to studies are even more prone to providing antibiotic prescriptions) permission to NOT prescribe an antibiotic. I think you need to make a pre-emptive strike. Tell them up front that you prefer not to take an antibiotic unless it is absolutely necessary, that you are fine with reassurance that you just need to “ride it out.” Use your doctors knowledge and experience, and have a conversation. I promise, you will both feel better.
Here’s to a happy, healthy holiday season!
Thank you all for your support this year. Please let me know how I can support you in the coming year.
*Nothing – the “nothing” I provide (I have gotten several patient complaints about this, so pardon the sarcasm) consist of a through evaluation,listening, a physical exam, thinking and an explanation of all of this, including why an antibiotic is not indicated, information of how to feel as better as possible despite our inability to instantly cure,; with as little risk and expense as possible, and the expected course of the illness (including the fact that you may have an extended period of cough, and what should cause you to return to the doctor. What I think needs to happen is we need to redefine what constitutes “nothing.”