We lack the will to solve antibiotic resistance

Recently, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating “so-called superbugs.” In this USA Today article, it states that superbugs “cause at least 2 million infections and 23,000 deaths each year.”

You know who is causing the problem, right? It’s doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you have the courage to dig deeper, antibiotic overuse is just a symptom of our broken health care system, unrealistic high expectations from society, and paralyzed government bureaucracy.

Consider these factors:

  • Where’s the tort reform? In the United States, it is our right to sue anyone we want to at any time and for any reason. Many people yell at hospitals for using too powerful antibiotics and this is the cause of resistance. “Antibiotic stewardship programs” are being put forth to limit hospital antibiotic use. Will this really work? If I have a patient pass away from an infection, and the attorney asks me why I didn’t use X antibiotic and I say it’s because of the “antibiotic stewardship program,” of course I will be labelled as someone who is looking more out for the hospital and not for the patient. My career will be over. Why risk that? I’m gonna prescribe that antibiotic. Don’t blame me. Fix the legal system, and then talk to me.
  • Where is Choosing Wisely? The Choosing Wisely campaign is designed to educate and make physicians order less “unnecessary” tests. It’s no secret that I’m skeptical about this. I challenge the campaign to add appropriate use of antibiotics to their recommendations. Will they? Let’s see.
  • Yes, I get paid when you’re sick. The broken payment system has been written about many times, and illustrated in movies like Escape Fire. I would rather be paid for high quality care, and not high volume of patients coming through my door. Many docs believe coming in for an office visit is quid pro quo for then giving an antibiotic.
  • I paid a $30 co-pay and didn’t get an antibiotic? For the foreseeable future, there will be the expectation of antibiotic since, “I had to pay such a high copay to see you.” Or, “next time, I’ll take my business elsewhere.” Or, “it doesn’t matter what you do, I’ll get my antibiotic here or at the urgent care.”
  • Where’s that rating sheet? Many patients know that patient satisfaction surveys factor into physician payment schemes. It has been written about many times that “the customer is always right” is maybe good business, but sometimes bad medicine.
  • You’re not making me get a flu shot. The unintended consequence of not immunizing is more and more use of antibiotics and antiviral meds — which, of course, will lead to more resistance. Just imagine how much antibiotic resistance could be slowed down if everyone received their recommended immunizations. Mind blowing, isn’t it?
  • Animals also get antibiotics. I only learned about this a few years ago. But, this is an easy fix, right? Here’s a quote from USA Today: “In 2012, the FDA asked food producers to stop putting antibiotics in animal feed to promote growth, but the guidelines do not have the force of law.” So, animals and humans will continue to get their antibiotics.

When it comes down to it, the medical issue of antibiotic resistance is like the political issues of trying to solve mass shootings, government spending, and immigration. We all know what the problems are. But, there is no real emotional or political will to actually solve the problem. So, we will continue to have mass shootings, we will continue to raise the debt limit, we will continue to allow illegal/undocumented people in this country, and, oh yeah, we will continue to have antibiotic resistance.

Go ahead. Tell me where I’m wrong here.

Mike Sevilla is a family physician who blogs at his self-titled site, Dr. Mike Sevilla.

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  • Thomas D Guastavino

    30 years ago when Iin medical school during my pediatrics rotation it was repeatedly brought out that antibiotics were being overused for children with viral infections. A wise old doc pointed out that no matter how hard you tried at times you were forced to make a choice between giving antibiotics to the child, or valium to the mother.

    • NormRx

      Reminds me of another story a pediatrician told me, “he rarely gives cough syrup to a child, he does prescribe it for the mother.” The old Robitussin ad where the child coughs one time and Dr. Mom runs for the cough syrup pretty much sums up this mind set.

  • Guest

    Most doctors seem fine with denying painkillers to patients who inappropriately request them. Why can’t they do the same with patients who inappropriately request antibiotics? “Just Say No.” Label the troublemakers “drug seekers” in their files so that others will be on the lookout for them. Stigmatize them. Make them too embarrassed to even think of asking.

  • Tiredoc

    This is actually an FDA problem. We need to retire classes of antibiotics in oral preparation form (leaving IV only) in rotation, letting resistance die back before reintroduction. Kind of like crop rotation. Constant harping about PCPs and colds won’t change that.

    • PCPMD

      Meh. I personally have good success avoiding antibiotics when not clinically indicated. The message of “drug resistant bugs” has entered the consciousness of the laypeople in my community sufficiently to where the mere threat of increasing that risk usually aids in avoiding antibiotic use. I take responsibility for my prescribing habits, as I think all physicians should. I don’t see the need for more government regulation in this matter.

      • Tiredoc

        No, this is exactly the area where more regulation is needed. You may be perfectly compliant, but your patients suffer because the doctor down the street isn’t.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Just a minor correction: Choosing Wisely does address some unnecessary use of antibiotics, which appears in both family medicine and pediatrics lists.

  • T H

    Come to my ER:
    I don’t refill chronic pain meds except in extraordinary circumstances.
    I don’t give abx for bronchitis, again except in extraordinary circumstances.

    It’s not hard to say no to the antibiotic expectors: it just takes practice and a good explanation.

    “Shirley has a viral infection. If I gave her antibiotics right now, she’s just probably get a rash and some diarrhea and you all have enough to deal with right now. If she’s still sick in two or three days, or if she gets worse, you can bring her back here or take her to your family doctor for a recheck.”

    And they get a handout with further precautions. A good patter and something else to hold on to besides the prescription sheet is mostly what is needed.

  • lauramitchellrn

    Although overuse of antibiotics in people has contributed to the development of resistant organisms, I believe (and have for many years) that it’s the antibiotics given to animals (e.g. cattle, chickens) that we end up eating is the major culprit.