Reduce antibiotic use through patient empowerment

Vox’s Julia Belluz wrote a nice article explaining why doctors overprescribe antibiotics. She essentially gives two reasons: doctors unsure of the diagnosis want to be “safe,” and patient demand.

But there’s a third reason that’s an extension of demand: patient satisfaction.

More patients have to take time off work to see their clinician, only to spend a few minutes in the exam room. Those who take that inconvenience likely won’t want a lecture on responsible antibiotic use. As Harvard policy professor Ashish Jha notes, “I completely understand why doctors do this: It’s so much easier to write a prescription than to spend 15 minutes persuading somebody they don’t need antibiotics.”

Now clinicians have to deal with the added specter of patient satisfaction scores. Not only from Web-based sites like RateMDs, Vitals or Healthgrades. But also from government-endorsed patient satisfaction surveys whose scores sometimes end up on physician online profile pages, and in some cases, factored into a clinician compensation.

It’s no wonder that many take the easier path and simply prescribe, than risk the potential minefields of doing the “right” thing, making patients unhappy, and giving a poor score.

Rather than simply telling clinicians to “prescribe less” — a relentless message leading to little improvement in prescribing practices — how about offering systemic solutions that take the burden off individual clinicians?

For instance: Break the paradigm of the 15-minute office visit, and give clinicians the time to have a real discussion with patients, and appropriately explain the pros and cons of antibiotics.

Also, reduce the emphasis on satisfaction scores. While they provide need information about the patient experience, they also provide the incentive to “treat to the test,” adding to the pressure to prescribe to keep scores high. And under no circumstances should patient satisfaction be linked to clinician reimbursement.

Admittedly, these are pie in the sky solutions that are unlikely to be implemented anytime soon. So what to do in the meantime? Here’s a suggestion: Leave the ultimate decision in the hands of patients. Spend some time and explain the potential upsides and downsides of antibiotics to patients in the exam room. Then write a paper prescription and hand it to patients. If their symptoms persist past a certain duration, they can choose to fill it, or not.

While far from perfect, it’s a reasonable balance between satisfying antibiotic demand through patient empowerment and reducing the number of prescriptions.

In lieu of systemic changes, it’s probably more actionable advice than simply telling clinicians to prescribe less.