Educating Patients About Antibiotic Use

Educating Patients About Antibiotic Use


With all that busy health care providers must
think about these days, sometimes real “communication” with the patient falls by the wayside. But there’s no question about it: Communication
plays a key role in good treatment outcomes. Especially when it comes to prescribing –or
not prescribing–antibiotics. You might have heard a lot recently about
antibiotic resistance—where antibiotics lose their effectiveness in fighting bacterial
infections. It’s a major public health concern. If we’re not careful how we prescribe and
use antibiotics now, these 20th century “miracle drugs” might not be effective in the future. While many of you understand the need for
greater antibiotic stewardship in the outpatient setting, the reality of practice is that sometimes
you are put in an awkward position. The patient comes in and may expect antibiotics. You don’t have abundant extra time to counsel
them. This video is intended to give providers communication
strategies to help patients understand antibiotic resistance and why antibiotics aren’t always
the answer. Say the patient has an upper respiratory infection
– likely viral. Here’s how a typical provider and patient
conversation might go: Doc, I’ve had this before. The green mucus, coughing, sneezing…I took
off work yesterday and I took extra time off to come
here today. When I saw Dr. Smith last
month for this same problem, she gave me an antibiotic. That seemed to take care of
it…. OK, I’ll call in a prescription. What pharmacy do you use? As a society, we are used to taking a pill
to cure what ails us. Too often, antibiotics are a “quick fix”
and inappropriately prescribed for viral infections—where they are not effective. If there is a question in your mind, or if
you worry the patient might not return or call if they don’t get better, you might
be tempted to prescribe antibiotics to cover the bases. Let’s rewind that conversation and see if
the provider could have made the point a little differently. She gave me an antibiotic. That seemed to take care of it. Sorry, no antibiotics for you. This is likely viral and antibiotics won’t
work. You’ll just have
to wait it out until your immune system naturally fights it. Maybe a week or two. OK, that likely won’t get the result the
provider was looking for. No patient wants to hear they’ll need to
stay home to fight an infection for two weeks. If the doctor had expressed empathy for their
concerns, briefly explained antibiotic resistance and shared specific steps in a plan of action,
the exchange would probably have gone better. Let’s try that again. She gave me an antibiotic. That seemed to take care of it. I understand how you’re feeling. Several patients have come in with the same
concerns this week. You may need to let your body use its natural
defenses to fight this. Taking antibiotics when they won’t work
could lead to other problems, like stomach upset or diarrhea. We are really re-thinking how we prescribe,
because antibiotics have been misused for years and are becoming less effective when
we really need them. And, please remember this: If you don’t
start feeling better in a couple of days, I want you to call the office again and we
can revisit this plan of action. You see what the prescriber did there? First, a statement of empathy and understanding
of the patient’s concern. Then, a course of action is outlined to relieve
symptoms. Patients respond well to details, not just
“Buy whatever cough syrup and cold medicine you like.” Next, a brief lesson on antibiotic resistance
and why antibiotics aren’t always the answer. Finally, recent medical literature indicates
patients want a contingency plan in case they don’t feel better in a few days. And guess what. It took less than a minute to say it. We timed it! You might also get a question like this… I just think I need the antibiotic. What’s the harm in giving them to me? Couldn’t really hurt, could it? Yes, it could. Antibiotics are a precious resource. If we give you antibiotics for a viral
infection—where they won’t work—that lets “superbugs” thrive and multiply. We might
come to a day where you or a loved one get a serious infection and there is no available
medicine to fight it. All because we inappropriately prescribed
antibiotics in the past. And, the more we are exposed to antibiotics,
the more resistant the bugs get. It’s important to remember that antibiotics
are medications and when you take antibiotics if they aren’t needed, they
can cause you direct harm. Some people have
allergic reactions or experience side effects from interactions with other medication they
are taking. Antibiotics can also disrupt your gastrointestinal
system and increase you risk of antibiotic-associated diarrhea, including
infectious diarrhea caused by Clostridium difficile. Research indicates there are four key strategies
when faced with a patient who may want antibiotics that are not indicated: Review the physical exam (PE) findings supporting
diagnosis of a cold. “Your lungs sound good, there is no sign
of pneumonia, your throat is red but it’s not a strep infection” State the diagnosis. “What we have here is a bad cold” Give your treatment recommendation. Details are usually welcome. “You can get plenty of rest, drink fluids,
take over-the-counter symptom relief, and us a vaporizer” Give a contingency plan. “If this isn’t better or becomes worse
in a couple of days, I want you to call us back” What about situations where an antibiotic
is called for – like bacterial infections? Some prescribers choose a broad-spectrum antibiotic-
when they’re not quite sure what the illness is or they fear they will miss some underlying
infection. Consider prescribing narrow spectrum antibiotics
targeted to work on a very specific infection. I’m not really sure what’s going on with
my pediatric patient. I’m just going to give him a
Z-pack and be done with it. You know, I’d be careful about that. Actually, amoxicillin is a better antibiotic
to target what the patient has, while avoiding unnecessary
side effects of a broader spectrum agent. The Centers for Disease Control and Prevention’s
“Get Smart Campaign” has many educational brochures, flyers and a viral prescription
pad – which is a “takeaway” for patients so if they can’t have a prescription, they
don’t leave the visit empty handed. Try some out in your waiting room or exam
room today. It might just make that conversation about
antibiotics a little easier!

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