Doctors work under a lot of pressure and it can undermine their decision-making. The better we understand that pressure, the better our care.

Why would our best and brightest get it wrong half the time? As many as 1 in every 2 antibiotics prescribed in the U.S. are unnecessary or inappropriate. Is that because doctors are incompetent, or don’t care if they get it right? Or is something else going on?

That’s what researchers at the University of Pennsylvania wanted to know and so they went directly to clinicians and asked them. And what they found is that these “well-intentioned individuals” work under crippling emotional pressure which in turn drives poor decision making. Lead investigator Julia Szymczak, PhD:

One of the most common and repeated themes that occurred across the data … was … this constant emotional experience of fear; fear of something happening to the patient, fear of being wrong, fear of being sued. And to alleviate that fear they [doctors] said, ‘we use antibiotics to comfort ourselves.’

In the following video and accompanying article, Dr. Szymczak explains how the burden of caring for sick people when too often doctors don’t know what’s wrong, and providing that care under the watchful eye of colleagues, patients and their families, triggers a “very strong emotional reaction to do something.” And how that ‘something’ invariably translates into “quickly put[ting] a patient on a broad-spectrum antibiotic in an almost automatic and unquestioned way.”

Szymczak’s insightful work isn’t about blame; it’s a plea for understanding, premised on the idea that understanding begins the road to better treatment – writ large. Because her work immediately invites a crucial question: If the pressures she identifies are indeed systemic as the physicians themselves say they are, then shouldn’t we be asking if medical decision-making is being compromised across the board?


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