Episode Transcript
Interviewer: Antibiotic resistant bacteria are a big public health concern. These superbugs are resistant to life-saving drugs that we take for granted. We'll talk about how changing doctors' attitudes about antibiotics could help overcome the problem, up next on The Scope.
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Interviewer: I'm talking with Dr. Barbara Jones with Ï㽶ÊÓƵ of Utah Health and the VA IDEAS Center for Innovation. First of all, what is a superbug, and why are they such a threat?
Dr. Jones: Well, superbugs are a bacteria that are resistant to standard antibiotic therapies. Bacteria can mutate with every generation, and some of these mutations can give bacteria resistance. When you're constantly exposing these bacteria to standard antibiotics, what emerges is a selection pressure for those bacteria that are resistant to those antibiotics.
Interviewer: Something that you helped to find in your research is that doctors are actually part of this problem of emergence of antibiotic resistant bacteria.
Dr. Jones: In many cases, we use antibiotics unnecessarily. And one of the biggest diseases that we do this in is in acute respiratory infections or kind of the common cold. Most of those diseases are caused by viral infections that really don't respond to antibiotics at all, and what we found across the VA system was that doctors just tend to get into habits. So some doctors prescribe antibiotics for colds almost every time that they have a patient with one. And other doctors, though, have figured out ways to prescribe a lot more judiciously.
Interviewer: And is this something that you experience? I mean, do you sometimes feel pressure to prescribe antibiotics when it might not be the best thing to do?
Dr. Jones: Well one of the things that I think is also a misperception for a lot of providers is we tend to assume that patients have an expectation that they'll receive the antibiotics, and when there's that assumption, when you only have 15 minutes to see a patient, you don't necessarily have the time that is taken to really get to know what your patient's expectations are.
And so if we then have a cultural assumption that our patients are expecting this, we have a busy clinic, we don't have a whole lot of time to educate our patients about the dangers of the antibiotics and why we would not prescribing, it's a lot of times easier to give the prescription than to have that conversation about the risks of antibiotics and what other things that you should do to take care of yourself during a viral infection.
Interviewer: Why is it important to understand these pressures that doctors face?
Dr. Jones: I think that the more we understand the perspectives of the providers and the physicians taking care of the patients, the more we can design interventions that support them to more rationally weigh the risks and benefits of antibiotics appropriately, and that will help replace some of the bad habits with better ones.
Interviewer: It sounds like what that means is changing behaviors, attitudes, habits, and that is not easy.
Dr. Jones: What we've found so far is giving providers data about their practicing of patterns is a really powerful tool to change behavior. So we call it audit and feedback, and what we've been doing across the VA settings that we've been implementing some of the stewardship efforts has been to show providers their prescribing patterns over a month or a six-month period and to show them kind of what their proportion of prescribing is and then start a conversation from there about what interventions they might be able to do to change their habits.
A couple other things have been clinical decision support systems that are often tied to an electronic health record. In a busy clinic, a lot of times you don't have a chance to have those important patient education conversations. If you have an electronic health record that supports prescribing symptomatic therapies that substitute that antibiotic or help print out a patient education handout, spend some of that time educating the patient for you, that can really help physicians feel like they're listening to their patients.
They're giving them the empathy that they need when they're feeling poorly, but also reserving the antibiotics for times that are more appropriate.
Interviewer: This is all a little different from the usual doom-and-gloom scenario that you hear about when it comes to superbugs. Are you optimistic?
Dr. Jones: Just like any shift, I feel like this is a cultural thing that can get to a tipping point. The more doctors start prescribing differently, the more their colleagues can see this and feel like they can change as well. I'm really optimistic that we can change our habits and our attitudes toward antibiotics, and so I think that some of these interventions for humans is really important. I think that if we do this, we can really impact that selection pressure and help reduce the emergence of superbugs.
Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.