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The UK has had a campaign asking patients not to ask for antibiotics for a cold or flu (and presumably asking GPs not to prescribe them), and also reminding pat

by scoot 10y ago

The UK has had a campaign asking patients not to ask for antibiotics for a cold or flu (and presumably asking GPs not to prescribe them), and also reminding patients who are prescribed antibiotics to complete the course, but it must be impossible to regulate, particularly in a more capitalistic health system. Disclosure: I live with a doctor. Irrelevant aside: Rare to find someone on HN call a disclosure a disclosure, rather than the oft-abused "disclaimer"! :)

wahern 10y ago
Doctors are learned professionals, and they have a professional responsibility not to prescribe ineffective medication. Importantly, antibiotics come with their own substantial risks. A whiny patient is not a good reason, and I've never met a doctor unwilling to turn down a whiny patient. It's only at the margins where a whiny patient can cajole a doctor, such as to increase dosage. Plus, whining is one piece of evidence used in diagnosing, and if the doctor has others reasons to believe there's something substantive, whining can nudge him along. The _crux_ of the issue is that doctors prescribe antibiotics for viral infections because the diagnosis is usually only based on a cursory examination. Their time is expensive, and you can't spend an hour on every patient with a cough and a fever. Furthermore, viral infections often precede or are concurrent with bacterial infections. So doctors are making a rational decision when prescribing antibiotics, and it's not even clear that this decision is globally suboptimal because bacterial infections are not uncommon with a cold or especially a flu. If we're serious about overprescription of antibiotics, we should be heavily investing in improved diagnostic equipment and processes. For example, rapidly scanning mucus samples for viral and bacterial markers. The fact that we don't appear to be doing this suggests that either overprescription isn't actually a problem, or that we're not thinking seriously about the problem.
- the_duke 10y ago
  I can only speak for the situation in Austria: In the past, doctors heavily over-prescribed antibiotics. Often as a precaution. The government and health providers have become very aware of an upcoming problem with high restistance though, so they are working hard to change the behaviour. Existing doctors are re-educated not to prescribe Antibiotics on a hunch, with monitoring and reprimands from health providers. And this is also drilled into med students in University. Change always takes time... let's hope we won't be too late to avoid a serious increase in fatalities.

by scoot 10y ago

wahern 10y ago

Doctors are learned professionals, and they have a professional responsibility not to prescribe ineffective medication. Importantly, antibiotics come with their own substantial risks. A whiny patient is not a good reason, and I've never met a doctor unwilling to turn down a whiny patient. It's only at the margins where a whiny patient can cajole a doctor, such as to increase dosage. Plus, whining is one piece of evidence used in diagnosing, and if the doctor has others reasons to believe there's something substantive, whining can nudge him along. The _crux_ of the issue is that doctors prescribe antibiotics for viral infections because the diagnosis is usually only based on a cursory examination. Their time is expensive, and you can't spend an hour on every patient with a cough and a fever. Furthermore, viral infections often precede or are concurrent with bacterial infections. So doctors are making a rational decision when prescribing antibiotics, and it's not even clear that this decision is globally suboptimal because bacterial infections are not uncommon with a cold or especially a flu. If we're serious about overprescription of antibiotics, we should be heavily investing in improved diagnostic equipment and processes. For example, rapidly scanning mucus samples for viral and bacterial markers. The fact that we don't appear to be doing this suggests that either overprescription isn't actually a problem, or that we're not thinking seriously about the problem.

the_duke 10y ago
I can only speak for the situation in Austria: In the past, doctors heavily over-prescribed antibiotics. Often as a precaution. The government and health providers have become very aware of an upcoming problem with high restistance though, so they are working hard to change the behaviour. Existing doctors are re-educated not to prescribe Antibiotics on a hunch, with monitoring and reprimands from health providers. And this is also drilled into med students in University. Change always takes time... let's hope we won't be too late to avoid a serious increase in fatalities.