> Instead, the researchers believe the answer is that doctors possess “superior information about guidelines” for prescription drugs — and then deploy that information for themselves. In the study, the difference in adherence to guidelines between experts and nonexperts is largest in the case of antibiotics: Doctors and their families are 5.2 percentage points less in compliance than everyone else.
After reading the title, this was my first thought.
From my perspective, as a full time software engineer, I imagine I am much less likely to follow PC troubleshooting steps in the same exact order as “prescribed” by an support person, than maybe an average joe who would follow the support guidelines strictly.
As the article suggests a little further down, the hypothesis is that they would prescribe broad spectrum antibiotics to themselves and family, as opposed to their patients.
> The latter [broad-spectrum antibiotics] might be more likely to eradicate an infection, but greater use of them also increases the chances that bacteria will develop resistance to these valuable medications, which can reduce efficacy for other patients.
Wife and I are physicians, 2 kindergarten aged kids, not sure any of us have had an antibiotic in the last decade. Most of my colleagues feel similarly with their families. Much more likely to give an antibiotic to a patient who doesn't have the medical expertise / patience to watch and wait, and for whom it's much less convenient to get an Rx later if they're getting worse.
Evidence on "completing the full course" seems pretty shaky, both in terms of outcomes and rates of resistance. If anything I would expect physicians to be erring on the "less is more" side of antibiotic Rx.
I haven't taken antibiotics in decades either. Whenever a doctor suggests it I ask for evidence of bacteria. I.e. do a test, and if that reveals a bacterial infection that won't pass on it's own, give me the antibiotics.
I find it weird that we would give out antibiotics if we don't even know yet that the issue is bacterial.
Especially because if it's not bacterial, an antibiotic will weaken your body.
An antibiotic won't significantly weaken your body. And there are many situations where prescribing antibiotics without a doing culture yields better outcomes because of timing. Particularly with severe illnesses like sepsis or severe cases of pneumonia, UTIs, and so on.
I worked in an ER room in Central Europe while I was studying medicine a while ago. We saved many lives by prescribing wide-spectrum antibiotics for advanced pneumonia without waiting for bac culture results. Once patients deteriorate beyond naturally getting enough oxygen, their chances of survival go down for every 12 hours the treatment is delayed.
I laugh when I see researchers say that medics should use narrow-spectrum antibiotics for patients like these. They forget "first, do no harm", which delaying treatment would undoubtedly do. Besides, no good doctor wants to kill their patients to be "right".
Aside from antibiotics, the off-label use of many medicines has helped many people tremendously. Doctors sometimes do know better than guidelines.
I agree that there are other, more grey-area situations with antibiotic use. Especially when doctors are a bit lazy and want to get done quickly with a patient with a mild infection, those situations are not very ethical. However, off-guideline use of antibiotics can save lives. That is my point.
This is correct. When treating the public, you stand a risk of being sued (at least in the US) for not following guidelines, but with yourself and family, you can put your nuanced and superior knowledge to work without worrying about the risk of being sued/ losing your license etc
9 comments
[ 3.1 ms ] story [ 33.9 ms ] threadAfter reading the title, this was my first thought.
From my perspective, as a full time software engineer, I imagine I am much less likely to follow PC troubleshooting steps in the same exact order as “prescribed” by an support person, than maybe an average joe who would follow the support guidelines strictly.
> The latter [broad-spectrum antibiotics] might be more likely to eradicate an infection, but greater use of them also increases the chances that bacteria will develop resistance to these valuable medications, which can reduce efficacy for other patients.
Wife and I are physicians, 2 kindergarten aged kids, not sure any of us have had an antibiotic in the last decade. Most of my colleagues feel similarly with their families. Much more likely to give an antibiotic to a patient who doesn't have the medical expertise / patience to watch and wait, and for whom it's much less convenient to get an Rx later if they're getting worse.
Evidence on "completing the full course" seems pretty shaky, both in terms of outcomes and rates of resistance. If anything I would expect physicians to be erring on the "less is more" side of antibiotic Rx.
I find it weird that we would give out antibiotics if we don't even know yet that the issue is bacterial.
Especially because if it's not bacterial, an antibiotic will weaken your body.
I worked in an ER room in Central Europe while I was studying medicine a while ago. We saved many lives by prescribing wide-spectrum antibiotics for advanced pneumonia without waiting for bac culture results. Once patients deteriorate beyond naturally getting enough oxygen, their chances of survival go down for every 12 hours the treatment is delayed.
I laugh when I see researchers say that medics should use narrow-spectrum antibiotics for patients like these. They forget "first, do no harm", which delaying treatment would undoubtedly do. Besides, no good doctor wants to kill their patients to be "right".
Aside from antibiotics, the off-label use of many medicines has helped many people tremendously. Doctors sometimes do know better than guidelines.
I agree that there are other, more grey-area situations with antibiotic use. Especially when doctors are a bit lazy and want to get done quickly with a patient with a mild infection, those situations are not very ethical. However, off-guideline use of antibiotics can save lives. That is my point.