Our last post featured Brad Spellberg, MD, a leader in the field of infectious disease, and his claim that the root cause of antibiotic over-prescription is fear among physicians. Namely, when they’re not sure whether to prescribe an antibiotic or not they will too often go ahead and do so, typically caving in to the demands of their patients. This drives antibiotic resistance, the phenomenon that is rendering our antibiotics increasingly useless.
But what, exactly, are these physicians afraid of? What is this fear based on? Perhaps not surprisingly, the answer seems to be income security – theirs.
This brutally honest admission came to us last month by way of NPR’s On Point, in their show titled “A Wake-up Call on Antibiotics Resistance.” A guy who has been an ER physician for over 20 years, in addition to being a private practitioner, called in (at the 25:35 mark) and explained what I will call the Doctor’s Dilemma. It goes like this. A “major issue,” he said, “is that a patient will come into the ER and demand from the physician an antibiotic. And if they don’t get it they’ll complain to the administration who’ll complain to the doctor and say either make our patient happy or you’re fired!”
He described a similar circumstance faced by doctors in private practice. The pattern is that “a patient will come in to the office and say ‘I’ve got a cold, the sniffles,’ or whatever, looking for antibiotics. So you try to educate them and say sinus infections are usually viral, and they will go to some other physician and may not come back to your office, and so it becomes a business issue.”
Dr. Michael Bell, from the US Centers for Disease Control was a guest on the program and said this is common behavior across the board. Unfortunately, Bell went on to say, we live in a “pill for every ill” society, and made the interesting observation that while we trust doctors when they say we should take something, we apparently don’t trust them when they say we don’t need something – like an antibiotic.
And so the systemic failure of physicians to properly resolve the Doctor’s Dilemma is what led Spellberg to offer this solution in his address last month at the Institute of Medicine:
“How do we deal with that fear? [i.e. the Doctor’s Dilemma]. We need technology. Relying upon asking people to behave differently [think hand washing] in a sustainable way is not going to get the job done. [W]e need regulators and payers, especially payers, to help us push these technologies into the clinic so that doctors don’t have the fear that creates the inappropriate antibiotic prescription. We need to hold these healthcare systems accountable for implementing these technologies as they become available.”
Writing in the New England Journal of Medicine earlier this year, Spellberg was more specific about what we need technology to do: “Infection prevention eliminates the need to use antibiotics. Traditional infection-prevention efforts must be buttressed by new technologies that can more effectively disinfect environmental surfaces, people, and food”.
Canada’s Vancouver General Hospital is ahead of the curve on using technology to “disinfect” people. They’re the first hospital in the world to adopt a new light-activated disinfection method that is expected to reduce infections in surgical incisions by 39 per cent and save almost $2 million a year. A trial of 5,000 patients reduced average re-admissions for surgical site infections to 1.25 cases a month from 4 and shortened hospital stays for surgical patients.
“What we’re doing now isn’t working,” says Spellberg. “If we want to have a future state where we’re not living with a crisis of antibiotics resistance we need to think disruptively. Incrementally tweaking what we’re doing is not going to get the job done.”
Vancouver General leading the way: