Doctors who prescribe too many antibiotics: It’s not that simple

[salvorhardin]

Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless thousands of lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers?

As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide a rationale for every antibiotic dose prescribed. The Centers for Medicare and Medicaid (CMS) is considering making this standard for every antibiotic dose, at every hospital, on every Medicare patient nationwide.

There’s every reason to have a rationale for antibiotics, or any other plan in patient care. But the development is part of what I perceive as a larger “pendulum swing” toward pressuring physicians to avoid prescribing empiric antibiotics whenever possible. That may not be such a great idea, since (unlike a lot of the things we do) antibiotics actually save lives on a fairly regular basis.

At academic training programs, a seductive and self-serving myth reigns: that doctors can usually know whether or not their ill-feeling patients are infected, and in what part of the body, and with what likely organisms. And all this can be done in a few moments, on rounds, with the internist’s tools of history, exam, and a few labs! This would be a miraculous feat if even one living physician could do it consistently — but in training programs, it’s presented as routine, a mundane and expected part of any physician’s job.

Full post: http://www.kevinmd.com/blog/2012/08/doctors-prescribe-antibiotics-simple.html

[hedgehog]

1. First, get antibiotics out of animal feed, then go after doctors!