How to get doctors to do the right thing is a perennial question in medicine. Whether in Phoenix, Arizona or somewhere else, many doctors just don’t like to be told what to do. They don’t like other people second guessing them. They resent anyone who presumes to interfere with their doctor/patient relationship or who would question their professional judgment. The problem is that many of the doctors who don’t want to be told what to do or be second guessed are making mistakes that can or do harm their patients. People committed to improving health care and reducing costs have been trying different ways to get these doctors to do the right thing.
I read recently about some experiments in trying to change physician behavior. One of the experiments dealt with the overprescription of antibiotics. Antibiotics do not work on viruses. As their name implies, they are to treat bacterial and not viral illnesses. Not only do unnecessary antibiotics risk the health of the patient, they lead to superbugs which are resistant to antibiotics and they drive up health care costs. Despite years of seminars, training and publications in medical journals, it is estimated that 30% of all antibiotic prescriptions are unnecessary. That equates to 47 million prescriptions a year in the United States. That is a lot of money being spent to accomplish nothing.
The researchers from Harvard and the Brigham and Women’s Hospital in Boston tried a number of different interventions to see which was most effective. When doctors who wanted to prescribe antibiotics were given alternatives to consider, it had virtually no impact on their prescription patterns over the year and a half that the study lasted. On the other hand, when they were required to write a justification before being allowed to prescribe antibiotics or when their prescription patterns were compared to “top performers,” they wrote significantly fewer prescriptions for antibiotics. Unnecessary prescriptions for the study group dropped from 20% of total antibiotic prescriptions to 4%. No one likes to be told that he or she is not a top performer or that they don’t compare favorably with top performers. This apparently is especially true with doctors.
Researchers are encouraged by their success in the area of prescriptions for antibiotics and are turning their attention to other perennial problems, including the use of “trigger alerts” to get doctors to follow up on important test results that might otherwise fall between the cracks. You can help with all of these problems by being an informed patient, by not pressuring your doctor for brand name medications, by not being a needy patient whom the doctor must satisfy by prescribing a medication just to make you believe he or she is doing something. The more you know about your condition, the better you should be able to work with your doctor to meet your mutual goal of a healthy you.
