Antibiotic Audit for Doctors

Majid Ali, M.D.

In March 2015, I completed work to comply with the new law requiring all doctors to “e-prescribe” all medications. The days of prescription pads were over. This was the culmination of one of long-awaited projects of “e-medicine.”

In March 2015, President Obama launched his $1.2 billion National Action Plan for Combating Antibiotic-Resistant Bacteria to seek a solution to the problem of human deaths due to superbugs. He ordered his scientists to focus on the use of antibiotics by American corporate agriculture.

I have two suggestions for President Obama:

1. Please also initiate a national program of auditing doctors’ use of antibiotics.

2. Initiate now an audit of how his $1.2 billion will be used.

The first audit should cost little, just the cost of some clicks to cull out the data concerning antibiotic prescriptions by individual doctors. This will be considered a self-serving statement since integrative physicians like myself prescribe fewer antibiotics in a year than most doctors do in a fortnight. Still, antibiotic audit of individual doctors will have some positive effects.

About the second audit, here is my prediction: the funds will disappear fast and there will ne nothing to show for it.

Drug-resistant superbugs kill 23,000 Americans a year, according to the Centers for Disease Control and Prevention. The agency never reveals how many of such deaths occur in individuals whose immune system has been suppressed by gut fermentation caused by toxicities of food, environment, and thoughts.

Patients Don’t Understand Risks of Unnecessary Antibiotics, GW Study Shows

George Washington University Professor David Broniatowski Led Study with Cornell and Johns Hopkins Universities – December 15, 2014

Over prescription of antibiotics is a major factor driving one of the biggest public health concerns today: antibiotic resistance. In a first-of-its-kind study, research led by the George Washington University suggests that public health educational materials may not address the misconceptions that shape why patients expect antibiotics, driving doctors to prescribe them more. The research appeared in October in the journal Medical Decision Making.

Researchers from George Washington, Cornell and Johns Hopkins universities surveyed 113 patients in an urban hospital to test their understanding of antibiotics. They discovered a widespread misconception: patients may want antibiotics, even if they know that, if they have a viral infection, the drugs will not make them better. These patients believe that taking the medication will not worsen their condition—and that the risk of taking unnecessary antibiotics does not outweigh the possibility that they may help.

“Patients figure that taking antibiotics can’t hurt, and just might make them improve. When they come in for treatment, they are usually feeling pretty bad and looking for anything that will make them feel better. These patients might know that there is, in theory, a risk of side effects when taking antibiotics, but they interpret that risk as essentially nil,” said David Broniatowski, assistant professor in GW’s School of Engineering and Applied Science.

Contrary to these patients’ beliefs, there are risks associated with taking unnecessary antibiotics, such as secondary infections and allergic reactions.

“More than half of the patients we surveyed already knew that antibiotics don’t work against viruses, but they still agreed with taking antibiotics just in case,” Dr. Broniatowski said. “We need to fight fire with fire. If patients think that antibiotics can’t hurt, we can’t just focus on telling them that they probably have a virus. We need to let them know that antibiotics can have some pretty bad side effects, and that they will definitely not help cure a viral infection.”

Dr. Broniatowski’s research found that most educational tools used to communicate the dangers of taking unnecessary antibiotics focus on the differences between bacteria and viruses—the idea that “germs are germs”—but do not address patients’ widespread “why not take a risk” belief.

While the study—Germs Are Germs, and Why Not Take a Risk? Patients’ Expectations for Prescribing Antibiotics In an Inner-City Emergency Department—was small, the results signal the need for a shift in the way health care officials educate patients and caretakers. Dr. Broniatowski urges members of the public health community to reconsider their communication tactics and adjust educational materials to address patients’ concerns and beliefs.

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