Shared Decision-Making Decreases Overuse of Antibiotics
I’m a chiropractor. I don’t prescribe antibiotics. But I care about the results of a recent research article on the subject of antibiotics.
In the research study, investigators looked at the role of educating patients about their disease process and including them in the decision making process. It seems obvious that we ought to be doing so. But it turns out that most doctor-patient encounters are one-sided.
Doctors and patients have predetermined outcomes.
One-sided doctor-patient visits come in two flavors.
- Patient sees a commercial on TV about some drug then comes to see the doctor. The patient describes some symptoms similar to the ones treated by the medication (but not an exact fit). The patient tells the doctor that they want to try the new medication, and the doctor capitulates. The patient had already made up their mind that they were going to take the medication. They just wanted a prescription filled.
- A patient comes into the doctor’s office for an evaluation. The doctor does a cursory exam and writes a prescription and instructs the patient to follow-up. There is no discussion, just a command from the doctor to the patient.
There is fault on both sides of the exam table when we see this. The patient, who had only a 30-second commercial education on a drug, is telling the doctor how to manage the patient’s symptom set. Additionally, doctors are usually only allowed 3 minutes with a patient case. That 3 minutes includes reading the patient chart, medical history, interviewing the patient and providing the treatment.
Team approaches work better
Research shows that best results occur when doctors and patients put their heads together and discuss the condition, causes, treatment options and outcomes. It does take a bit more time, but the results are well worth the investment.
In the research study conducted at Laval in Montreal, Quebec, patients who had convinced themselves they needed an antibiotic to fight a lung infection were educated by their medical doctor about the difference between viral and bacterial infections. The patients with viral infections were not given antibiotics (thankfully). Reducing the abuse and overuse of antibiotics makes the effectiveness of the antibiotic stronger by reducing the risk of pathogens developing resistance to it.
In the case of the lung infections, only about 5%-15% of the cases involve bacteria. The vast majority of the cases are viral, which does not respond to antibiotics. Imagine if someone told you to play relaxing music to heal your sunburn. Music has no effect on a sunburn. It might take your mind of the pain of the sunburn, but it has no therapeutic effect. Using antibiotics on a viral infection is just as dumb. Doing so might help reduce the risk of a super-infection, but it is not worth the risk in most cases.
Our approach is education-centered, team-focused
In my office I educate my patients. If a patient tells me where and how to adjust them, I ask them more questions about how they arrived at that decision, then re-evaluate their thought process. An educated patient is one which will make better healthcare decisions generally, they tend to be more compliant, and they get better results.
I do a lot of 2nd opinion work for patients. Often a patient of another chiropractor will come to me describing their injury and the treatment plan from another doctor. I try to explain the rational behind the different options and what goal the chiropractor had in making specific treatment recommendations. When the patient leaves, they feel better about their choices and they tend to follow the chiropractors recommendations.
If your doctor is not listening to you or does not spend enough time hearing your complaints, give me a call. I will make time for you. You deserve better.
Featured image courtesy of FreeDigitalPhotos.net and Ambro