I have a confession to make.
I prescribe drugs of abuse on a regular basis.
No, it’s not Oxycontin, Methadone, Vicodin, Percocet or even Fentanyl. It’s not Valium, Ativan, Lorazapam or Xanax. It’s not even Tramadol. I don’t have a problem prescribing these medications when clearly indicated. I don’t have a problem saying no to prescribing these medications when not indicated. I also live in a state where marijuana is illegal, so I don’t prescribe this and would not even if it were. Even when patients bully me my No means No. In fact, persuasion to receive these medications throws a red flag up that I do not put down.
What I prescribe is antibiotics. Amoxicillin, Azithromycin, Doxycycline, Cephalexin among others flow out my e-prescription bin like water going over Niagara Falls. I have practiced as a physician assistant for more than 20 years. Conference after conference, webinar after webinar, CDC report after CDC report the message is clear. Do not prescribe antibiotics inappropriately. I know the difference between viral and bacterial infections. I don’t take antibiotics when my body is being ravaged by a virus. I know that I will be sick seven to twenty one days no matter what I do. I also know that I may cough up to six weeks if I develop bronchitis. An antibiotic may give me diarrhea, yeast infections and may even cause c. difficile. Speaking of c. difficille, I have seen how sick it can make people. I have seen patients hospitalized. Lose significant amount of weight and occasionally become critically ill. The risk exists with even the most benign of antibiotics. So why do I prescribe so freely. Quite frankly, my patients expect it. We live in an “I want it now society”. Our patients are now trained as consumers. As providers we are under the gun to see more patients in less time while documenting more and meeting quality standards. I can send a prescription to the pharmacy in less than one minute. It is going to take me 2-5 minutes to educate a patient about viral and bacterial infections. I then am going to have to answer 2-3 phone calls per patient not prescribed an antibiotic over the next week. They will be requesting an antibiotic because they are no better. It is a matter of time and economics. Patient satisfaction also plays a role.
Satisfaction plays an important part in our quality grades. We are expected to meet our customer’s (patient’s) needs. Remember, “the customer is always right.” Well, we all know that our customers, our patients are not always right. How many times have you discussed the difference between a viral and bacterial infection. Your patient tells you that “antibiotics don’t help viral infections and that they just got to run their course.” You think , WOW finally someone got it. You may even give them a hand out about viral vs bacterial infections. You spend the time. You educate them. They seem happy. They understand that 2 days from now they won’t be cured. Wow, THEY UNDERSTAND. FINALLY. One or two days later they are “no better” and now want you to call a prescription in for their infection. Your task bin is full of requests for antibiotics for people diagnosed with viral infections. How many times do you acquiesce? Well, my energy level runs short, I can’t answer all those phone calls personally. The possibility of creating a patient complaint to my supervising physician, my employer, or the state medical board is not worth the risk.
I know that I am not alone. According to the American College of Physician’s there are 190 million doses of antibiotics administered daily in hospitals. Of the 133 million courses of antibiotics prescribed in the United States to outpatients every year, 50 percent of these are unnecessarily prescribed for colds, bronchitis and other viral infections.
I am trying this again. I am not going to prescribe antibiotics for viral infections or exacerbations of asthma. Just like quitting smoking, the one hundredth time might be the charm. I am handing information or emailing information from the:
CDC program (http://www.cdc.gov/getsmart/),
American College of Physicians (http://www.acponline.org/patients_families/pdfs/health/antibiotics.pdf)
I am going to try again. I hope I am successful. I am sure there will be setbacks. Hang in there. One day at a time.
I have a confession to make.