An antidote for spineless prescribers

Doctors know not to prescribe antibiotics for viruses, yet patients often demand such drugs when they visit the doctor for a cold or flu. The result: antibiotic resistance and wasted money. Researchers at Harvard Medical School experimented with damping the demand for such inappropriate treatment with simple educational materials for patients. It wasn’t that successful: the best they could say was there appeared to be some improvement in knowledge among Medicaid recipients. Who knows whether that will translate into any real differences in antibiotic use. I’m skeptical.

Here are a couple other ideas:

  • Train physicians to deflect requests for inappropriate antibiotics. Some are worried about losing patients to other physicians who write Rxs more liberally. That could be addressed by community-wide efforts at MD education. Ok, I’m skeptical of this idea, too.
  • Require prior authorization for antibiotics in the case of viral diagnoses. That will stop docs from writing inappropriate Rxs or at least let the health plans and Medicad be the bad guys and say no if the docs can’t handle the chore
April 10, 2007

3 thoughts on “An antidote for spineless prescribers”

  1. Require prior authorization for antibiotics in the case of viral diagnoses.

    That won’t work. Patients and docs will quickly learn to fudge the diagnosis; claim that the Rx is for a “bacterial sinusitis” instead of a “URI.” Make the doc submit copies of records documenting a fever? Just how much of a hassle is it worth?

    For the record, my problem is ENTs who give antibiotics for “sinus infections” that are rarely bacterial. Most of the primaries in my area are better than that, but what can you do when people self-refer?

  2. Number one is the only idea that’ll work, really. Here’s another: train your PARENTS early with their first children.

    The parents who’ve “grown up” with me are much MUCH less likely to ask for ABX than parents who’ve transferred to me from other docs, who in turn have trained the parents to expect ABX for prolonged (or sometimes not prolonged) cold symptoms.



  3. Another idea –probably also infeasible– is to market a placebo antibiotic, (Virocyllin or Pathocycline?) and have prescribers use that when they can’t say no. It can serve as a heads up to pharmacists to counsel patients when they fill it. And the placebo effect should be at least as effective as an antibiotic.

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