Doctors routinely prescribe antibiotics for flu and the common cold, even though the drugs don’t work with those conditions. Up to half of all antibiotics are prescribed when they shouldn’t be, adding to health care costs, and deepening the problem of antibiotic resistance.
There are several reasons why doctors do it, according to a new paper. One is “defensive medicine,” in which physicians try to cover themselves against lawsuits. Others include ignorance of guidelines, patient pressure, and the fact that everyone else is doing it (“workplace culture”).
In other words, it’s clear that doctors, like the rest of us, aren’t completely rational. Despite the scare stories about antibiotics, they still prescribe them knowing they’re both useless and harmful. There are psychological and social factors at play, the paper says, including the “desire to conform to behavior of peers” and “concern over the opinion or approval of one’s associates.”
Researchers therefore decided to attack the problem as a behavioral issue, in a sense reversing the psychology. Their solution: a simple poster-sized letter on the wall of exam rooms, explaining the dangers of antibiotics, along with a signed commitment to reduce inappropriate use. By getting doctors to make a commitment in front of their patients, they figured they might be encouraged to change.
It worked, to an extent. When they compared the level of unnecessary prescriptions in clinics that had posted the notice with a control group that hadn’t posted, they found that the first group reduced inappropriate dosages by about 10%.
A 10% reduction may not sound like a lot. But it could be in the context of the wider health system. If the result was mirrored across the U.S., it could eliminate 2.6 million unnecessary prescriptions a year, and save money at the same time.
In an email, lead author Jason Doctor, at the University of Southern California, says it wouldn’t be difficult to sign up doctors. “It would be very simple: clinicians would voluntarily commit by signing the letter. These would be blown up to an 18” x 20” poster and placed in the exam room along with a picture of the provider(s).”