Best way to stop overprescribing antibiotics? Public shaming, of course

Doctors may be as irrational as the rest of us mere mortals, researchers say.


Read the whole story

 

[SixDegrees]

LuDux[/url]":musy761h]Overprescribing or underprescribing, either way people die.

Maybe what we should focus on instead is correctly prescribing.

How many people die from colds?

How many people die from colds as a result of not being prescribed antibiotics?

 

[marsilies]

LuDux[/url]":3ndhf0n8]Overprescribing or underprescribing, either way people die.

Maybe what we should focus on instead is correctly prescribing.

I'm not sure you actually understood the article if you think anyone was advocating something other than correctly prescribing.

 

[XtinaMS]

“But what if doctors are a little irrational, like the rest of us?”

Just a slob, like one of us...

 

[lint gravy]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

 

[tetrapyloctomy]

At least this is better than the new sepsis guidelines, that basically encourage extreme over-response to vital sign abnormalities lacking any specificity for severe disease.

 

[GenocideOwl]

lint gravy[/url]":1jd582uf]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

no. stop it. never ever ever ever ever recommend those people for anything.

 

[Carewolf]

anon_coward[/url]":26tvlxkf]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

Well, that might be a bigger problem, but this is still a problem.

 

[Umfrot]

anon_coward[/url]":3vmxdn8s]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

That's another problem, actually an even bigger problem than this one.

But this article is about THIS problem, not THAT problem.

 

[Z1ggy]

carcharoth[/url]":3jmfcorq]oh, education doesnt work?

im not apposed to using shame as a tool, but the term "shaming" brings to mind adolescent rants and people yelling at each other like children

additionally, if its OK to antibiotic shame, then dont get all weepy when someone "shames" you for something else, like being fat

well apparently over prescribing antibiotics can lead to being over weight.
http://meincmagazine.com/science/2016/03/ ... r-obesity/

EDIT: round and round we go.

 

[JustinB]

I knew it wouldn't be, but some little part of me was hoping for doctor shaming pictures a la the current cat shaming memes. (Look up "cat shaming" if you haven't seen it ... good for a few chuckles.)

 

[foxyshadis]

Umfrot[/url]":4u9szkxv]

anon_coward[/url]":4u9szkxv]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

That's another problem, actually an even bigger problem than this one.

But this article is about THIS problem, not THAT problem.

Also, the same technique should work on livestock docs as people docs. No reason why it wouldn't.

 

[bortholomew]

anon_coward[/url]":28ki9o3c]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

You ever try to shame a cow? It just doesn't work.

 

[sls1j]

"and cut antibiotic prescriptions by 20 percent. In another method, doctors were forced to write justifications for antibiotic prescriptions that other medical professionals could review. This cut prescriptions by 77 percent." -- not because of shaming but having to avoid writing the justification (whatever works) unless the doctor doesn't prescribe when he should to avoid the same paper work.

 

[lint gravy]

GenocideOwl[/url]":29mkbmiz]

lint gravy[/url]":29mkbmiz]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

no. stop it. never ever ever ever ever recommend those people for anything.

Well, I agree, but unfortunately you can't get timewasters and hypochondriacs to go to clinics labeled

FAKE PLACEBO CLINIC FOR BONEHEADS WHO WON'T SEEK REAL TREATMENT OR HAVE NOTHING WRONG WITH THEM

So until we figure something out we have two choices; waste real medical resources on them, or send them to fake practitioners. But we have to call those fake practitioners something that will clue the rest of us in to avoiding them favor of real doctors without tipping off the hypchondriac. "Naturopath", "Homeopath" and the like seem to be accomplishing that task.

 

[TheMerricat]

foxyshadis[/url]":2udxkpup]

Umfrot[/url]":2udxkpup]

anon_coward[/url]":2udxkpup]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

That's another problem, actually an even bigger problem than this one.

But this article is about THIS problem, not THAT problem.

Also, the same technique should work on livestock docs as people docs. No reason why it wouldn't.

Sure there is, the bonus in the pay check the doc gets when their stock gains 40% more weight while on antibiotics than when not. Somehow I don't think any amount of shaming is going to convince those docs not to fill the syringe.

 

[Maltz]

Past strategies “are all based on the assumption that physicians are rational agents who will do the right thing if provided proper information and incentives,” researchers Craig Fox, Jeffrey Linder, and Jason Doctor wrote Sunday in The New York Times. “But what if doctors are a little irrational, like the rest of us?”

Is this supposed to be some kind of revelation? I wonder if society will ever learn this lesson once and for all. Humans don't always act rationally, or even necessarily in their own self-interest. Not to say that people are inherently evil or anything, they're just people. You have to design the system to work around human nature as-is. When you try to design an "ideal" system in a vacuum and then drop people into it; that's when you've paved your road with good intentions.

 

[giltwist]

No need for shaming. Just some head-ology.

 

[operagost]

lint gravy[/url]":19i23yel]

GenocideOwl[/url]":19i23yel]

lint gravy[/url]":19i23yel]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

no. stop it. never ever ever ever ever recommend those people for anything.

Well, I agree, but unfortunately you can't get timewasters and hypochondriacs to go to clinics labeled

FAKE PLACEBO CLINIC FOR BONEHEADS WHO WON'T SEEK REAL TREATMENT OR HAVE NOTHING WRONG WITH THEM

So until we figure something out we have two choices; waste real medical resources on them, or send them to fake practitioners. But we have to call those fake practitioners something that will clue the rest of us in to avoiding them favor of real doctors without tipping off the hypchondriac. "Naturopath", "Homeopath" and the like seem to be accomplishing that task.

Or just prescribe a placebo.

You act as if the problem hasn't already been solved.

Hint: it doesn't say "placebo" on the prescription. There are code words.

 

[lint gravy]

operagost[/url]":1tm0dl8l]Or just prescribe a placebo.

You act as if the problem hasn't already been solved.

Hint: it doesn't say "placebo" on the prescription. There are code words.

If you're being serious (which by the way I wasn't) you should be aware that really doing this is under ordinary circumstances contrary to accepted medical ethics and can get a (real) doctor in quite a bit of trouble.

 

[cornofear]

"acknowledge that people do not always behave rationally and are strongly motivated by social incentives to seek approval from others and compare favorably to their peers."

I support the ideas discussed in the study, but I'm a bit baffled by this comment. Why exactly is it irrational to seek approval from others and try to compare favorably to one's peers? That is, after all, part of peer review.

 

[enilc]

operagost[/url]":3pi65ikk]

lint gravy[/url]":3pi65ikk]

GenocideOwl[/url]":3pi65ikk]

lint gravy[/url]":3pi65ikk]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

no. stop it. never ever ever ever ever recommend those people for anything.

Well, I agree, but unfortunately you can't get timewasters and hypochondriacs to go to clinics labeled

FAKE PLACEBO CLINIC FOR BONEHEADS WHO WON'T SEEK REAL TREATMENT OR HAVE NOTHING WRONG WITH THEM

So until we figure something out we have two choices; waste real medical resources on them, or send them to fake practitioners. But we have to call those fake practitioners something that will clue the rest of us in to avoiding them favor of real doctors without tipping off the hypchondriac. "Naturopath", "Homeopath" and the like seem to be accomplishing that task.

Or just prescribe a placebo.

You act as if the problem hasn't already been solved.

Hint: it doesn't say "placebo" on the prescription. There are code words.

Or...we could get the doctors to do their job. Stop prescribing out of laziness and grow a backbone when dealing with patients that demand some kind of prescription.

But, I guess it's much easier to blame the stupid people who didn't go to medical school.

 

[shieldw0lf]

1) Shamed in public for xyz.
2) Attract extreme reactions from strangers. Some hate you now, some love you now
3) Oppose and reject those who hate you.
4) Assist and embrace those who love you.
5) Congratulations. You are no longer a moderate where xyz is concerned. You have been transformed into an extremist. Xyz is now an integral part of your identity.

 

[AlmostRemember]

A growing number of studies have found that trashing your microbiome can have very serious consequences. Obesity was already mentioned above. It can also create openings for pathogenic bacteria to take hold. Then there is the fascinating fact that up to 90% of some neurotransmitters are manufactured by gut bacteria. This is still a relatively new field of research with lots more to learn.

Point being, educating patients about the importance of their microbiome could be effective some situations. If someone doesn't care about overuse of antibiotics impacting everyone, perhaps an appeal to their selfish interests would work.

 

[SixDegrees]

anon_coward[/url]":2pjuih0k]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

It's a huge problem nonetheless. Somewhat remarkably, abuse of antibiotics in farm animals hasn't led to many bacteria that infect humans becoming resistant (yet). The really problematic human pathogens are those that have become resistant while treating humans.

Finally, there's nothing at all suggesting that attacking separate problems separately is a bad thing.

 

[d4Njv]

The solution has to ultimately start in the public education system, where the concept of antibiotic resistance should be as essential as that of antibiotics in science curriculums.

 

[usamaahmad]

enilc[/url]":1u11b1of]

operagost[/url]":1u11b1of]

lint gravy[/url]":1u11b1of]

GenocideOwl[/url]":1u11b1of]

lint gravy[/url]":1u11b1of]

or pressure from patients who may see an antibiotic as a cure-all and demand a prescription.

This is the one thing homeopaths are good for: you can send patients like these to them.

no. stop it. never ever ever ever ever recommend those people for anything.

Well, I agree, but unfortunately you can't get timewasters and hypochondriacs to go to clinics labeled

FAKE PLACEBO CLINIC FOR BONEHEADS WHO WON'T SEEK REAL TREATMENT OR HAVE NOTHING WRONG WITH THEM

So until we figure something out we have two choices; waste real medical resources on them, or send them to fake practitioners. But we have to call those fake practitioners something that will clue the rest of us in to avoiding them favor of real doctors without tipping off the hypchondriac. "Naturopath", "Homeopath" and the like seem to be accomplishing that task.

Or just prescribe a placebo.

You act as if the problem hasn't already been solved.

Hint: it doesn't say "placebo" on the prescription. There are code words.

Or...we could get the doctors to do their job. Stop prescribing out of laziness and grow a backbone when dealing with patients that demand some kind of prescription.

But, I guess it's much easier to blame the stupid people who didn't go to medical school.

I'm not saying this at all justifies the practice of some physicians prescribing antibiotics, but for those not salaried, patient satisfaction is part of the issue. In fact many payors (insurance companies) will also be measuring patient satisfaction. It's a conflict of interest, in specific situations, such as this one. A doctor knows it would be better not to prescribe antibiotics but if they also have to worry about their business (to have a repeat customer) or Yelp reviews or how insurance companies view them, then it just adds completely unrelated factors into the decision making process. Not everyone is willing to see House, MD.

Personally being at an academic institution has helped shield us from some of this. I practice the rule of asking the patient to call me back if 10 days later symptoms are still there AND not improved, OR if they get significantly worse they can call back earlier, or future dating scripts if they really want something in hand but again future dates for 10-14 days. I like the Public Shaming idea, though.

I also like what d4Njv said about public education. I am surprised how many times I find myself explaining to young patients (20s, 30s) the difference between viruses and bacteria.

 

[SixDegrees]

d4Njv[/url]":g1hv2mv8]The solution has to ultimately start in the public education system, where the concept of antibiotic resistance should be as essential as that of antibiotics in science curriculums.

They already cover antibiotic resistance in school. It comes up when evolution is presented, and it's a classic example of selective pressure.

People have already been given this information. It doesn't fix willful ignorance.

 

[usamaahmad]

SixDegrees[/url]":32h42imh]

d4Njv[/url]":32h42imh]The solution has to ultimately start in the public education system, where the concept of antibiotic resistance should be as essential as that of antibiotics in science curriculums.

They already cover antibiotic resistance in school. It comes up when evolution is presented, and it's a classic example of selective pressure.

People have already been given this information. It doesn't fix willful ignorance.

Antibiotic resistance is a problem for "the other," and many choose to ignore it and think about themselves, and wanting to get better quicker, so they don't have to suffer.

To that end I also explain that they most likely have a virus and that antibiotics will not help. More often than I would expect, this is met with either a confused look or skepticism.

 

[fishbait]

*insert rant about antibiotics and cattle*
*insert rant about babies and antibiotics*
*insert rant about vaccines and antibiotics*
*insert rant about corrupt doctors and big pharma*
*insert various forms on insults to intelligence*
*insert various forms of insults to ego*
*insert various forms of insults to mother*

there can this topic not derail please?

 

[Pyros]

bortholomew[/url]":2tz04pba]

anon_coward[/url]":2tz04pba]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

You ever try to shame a cow? It just doesn't work.

Everyone knows cows are the most shameless of all common barnyard animals.

 

[VidasDuday]

anon_coward[/url]":17b19eca]can't see how this is a huge problem when most antibiotics are made for use in animals and given for no reason

Punctuation. Because it's a thing.

 

[Velma Velvet]

Even if doctors hadn't overprescibed antibiotics bacterial resistance would have happened anyway because that's how evolution works. Bacterial resistance was observed almost immediately after penicillin was introduced. The issue with some non-involved party is that they don't see what the doctor does.

Antibiotics may be ineffective against colds but they're very effective against bacteria that likes to grow in the gooey, immune-stressed environment cold ravaged lungs and sinuses provide.

Antibiotic resistance will be a problem if every doctor follows the guidelines 100%. Antibiotic research has to be done on a continual, ongoing basis. It doesn't mean doctors should just prescribe away.

It's a biological reality that can be mitigated but never eliminated.

 

[Ledgem]

This is just one more point of pressure that doesn't address why physicians are doing what they are doing. I'll write about this from my own point of view and my own practice, but I'd be surprised if it didn't hold true for many other doctors as well.

There are two or three major factors that come into play when it comes to prescribing an antibiotic. The first is simply wanting to feel that you're doing something for your patient. I recognize that my patients have taken time out of their day to come to the office; for some of them, it has also taken considerable effort and expense (those from poorer economic backgrounds). I feel badly for the patient when I tell them that it is most likely a viral illness that antibiotics will do nothing for, and that they have no choice but to weather it. I try to make it worth their while by offering advice and in some cases medications for symptom relief, but feel that overall they could have come to the same outcome by buying some over-the-counter medications from their local drug store.

It is worsened when the patient pushes hard for antibiotics. I try to educate them on the fact that antibiotics don't work on viruses, and that antibiotics aren't a completely benign thing in themselves (something that we're only starting to more fully understand). But how well can I go through those topics in 15 minutes, of which only about 5-7 minutes can be devoted to a discussion? How receptive will the person in front of me be when they may not really understand or care about these topics, but know that they're suffering and are in search of a quick fix?

Yet another brick has been added to the burden with the way that insurance companies are attempting to tie patient satisfaction to physician payouts. Don't give a patient antibiotics and they'll probably rate you poorly, whether it's because they feel that you did nothing for them or because you "have a big ego" and "are lazy" (to quote one of the comments above). And now you want to add yet another rating system to physicians, given all of the other variables putting pressures on their actions? A rating system like this might have been good for the days when physicians were "all powerful" and commanded total respect (if such days ever truly existed); the modern physician is in a very different position, I assure you.

I don't think that's helpful. Rather, what is helpful is the development of methods to navigate our current system. An article was published within the last few months that sought to decrease the number of antibiotics prescribed. Instead of putting more pressure on the physician, it sought to find a way to give physicians a way to work with their patients and still have a good outcome. The tactic is called "delayed prescription strategy," and while there are a few different ways to go about it, the overall idea is that the patient will receive antibiotics after a certain amount of time. This way the patient doesn't feel written off, and they also note that they start to feel better even without the antibiotics... and don't use them. Fewer antibiotics are used, the patient is still satisfied, and it's an overall better outcome.