The Fear Factor: A Leader in the Field of Infectious Disease Says Doctors Habitually Over-Prescribe Antibiotics Because They’re Too Afraid Not To. What is it They’re Afraid of?
Yesterday we reported on the Harvard School of Public Health’s plea to the public to please stop asking their physicians for antibiotics. In their view “They [the public] need to be a partner in using antibiotics properly,” and “We’re all in this together.”
Fair enough. But of course there’s someone else involved in this illicit relationship of over-prescription – our friendly neighborhood physician. And so the question arises: Why are they doing it? Why are they giving out antibiotics when they shouldn’t? Presumably they know better, so what’s going on?
Enter Brad Spellberg, MD; physician, researcher, and a leader in the field of infectious disease and antibiotic resistance. As far as doctor’s go this guy is not your average bear. Extremely well-credentialed, he stood in front of a select audience this year at the prestigious Institute of Medicine and revealed this uncomfortable truth:
The root cause of why antibiotic [over] prescriptions occur is simply fear. Fear of the unknown. We as treating physicians do not know what our patients have with certainty. We make our best guess. And that guess is haunted by the fear that we could be wrong. And that’s what leads to this ‘Well, what if it’s bacterial, how much harm could one prescription do?’ And so we need to deal with that fear. Everything else is putting a band aid on the problem.
Here’s what he’s talking about. Antibiotics don’t work for the common cold, the flu, most ear infections and respiratory problems, because they’re typically viral-based illnesses. Physicians know this. But they’re overrun with patients pleading for antibiotics, often-times for their sick kids. So the physician has a choice. She can order a diagnostic test to see what germ they’re dealing with, knowing that it will take 3 days to get the result. Or she can take 10 minutes to explain bacterial vs. viral-based disease, which the patient may or may not understand, and if they don’t they’ll leave the office disappointed and may well change doctors. Or she can cave in to the demand on the basis of “What’s the harm? Besides, who knows, maybe it’ll do some good.” It’s this faulty last choice that Spellberg is saying is too often made.
And we know that that choice does damage. An inappropriately prescribed antibiotic puts patients at risk for allergic reactions, super-resistant infections, and deadly diarrhea caused by Clostridium difficile. These practices also drive antibiotic resistance, further endangering the future of antibiotics and the patients who need them.
Notwithstanding this huge downside a report in the New England Journal of Medicine estimates that 50% of antibiotic prescriptions may be unnecessary. Health care providers prescribed 258.0 million courses of antibiotics in 2010, which translates into over 8 prescriptions for every 10 people. Prescribing rates were higher with kids under 10 years of age and persons 65 years of age or older. In other words, we’re getting it wrong half the time and it’s the vulnerable among us that are most hurt by this.
All we want to do is give the right antibiotic to the right people and not give it when it’s not necessary. However, before we can realistically think of getting there, Spellberg is saying his colleagues need to first fill this prescription: Physician, heal thyself.
Here is Dr. Spellberg’s talk: