Medical Self-Defense: Your GP probably shouldn’t be allowed to prescribe antibiotics as they’re not the drug we thought they were. This means you have to learn about them.
Interesting perspective, as always (e.g. here & here), from Brad Spellberg, MD, Chief Medical Officer of the Los Angeles County-USC Medical Center, on how to fix the overprescription problem of handing out antibiotics like candy “just-in-case“: only allow the infectious disease specialist to prescribe them.
Oncologists don’t let non-oncologists prescribe chemotherapy. The single biggest mistake that our specialty made over decades and decades is that we’ve allowed anyone to prescribe these drugs, and the perception has been that they’re so safe and so effective you don’t need to be an expert in them. The result of that is a complete lack of control of use.
And you know as well as I Paul when you’re rounding on ID and you get consults and you go, “I can’t believe the drugs these folks are using.” Well, if we had the ability to say, “No you don’t get to use those drugs, only we can authorize the use of those drugs,” we would have a much better ability to protect these drugs.
Here’s the problem Spellberg’s addressing: Around a third of all antibiotic prescriptions handed out in the U.S. are done so in error. It’s either the wrong drug, the wrong duration, the wrong dosage, or the antibiotic shouldn’t have been given out in the first place, typically because the illness is viral, not bacterial. As a consequence, we’re losing our antibiotics. And since they’re wedded to the everyday practice of medicine – e.g. to prevent infections in surgeries, burn patients, & cancer patients undergoing chemo – the loss of them would mean a serious decline in health care, and perhaps something worse than that.
Spellberg concedes that “the cat is out of the bag,” that we’re not going to be able to take away the antibiotic prescription privilege from the family doctor. Therefore, Spellberg implies, we need to practice medical self-defense. In the same way that we learn good health habits, basic first aid & CPR, we simply have to learn when and when not to use antibiotics. It’s actually not very hard, and it’s interesting stuff. Here’s the short version, from the CDC. But the best messaging out there – this is interesting – remains this eye-opening public forum put on by the Harvard School of Public Health. Don’t be intimidated because it’s Harvard. The discussion is for everyone. And it’s got it all. Our take on it is here.