Dr. Peter Pronovost (@PeterPronovost) is a practicing anesthesiologist, critical-care physician, professor, Johns Hopkins Medicine senior vice president and director of the Armstrong Institute for Patient Safety and Quality. He blogs from Voices for Safer Care.
None of us wants to live in a world without access to lifesaving antibiotics. No patient should be subject to an allergic reaction or organ dysfunction from these drugs. No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out healthy gut bacteria.
Yet, every day, patients are prescribed antibiotics that they did not need or that are not clinically indicated, exposing them to the risk of these harms. In clinics, 30% of prescriptions are unnecessary. In hospitals, 20% to 50% of antibiotic use is considered inappropriate; in long-term care, it’s 75%. This overuse and misuse also contributes to the spread of multidrug-resistant organisms, diminishing our arsenal of these agents.
Certainly, physicians need the latest guidelines on how to prescribe for different clinical conditions, or whether to prescribe at all. But slapping educational posters in the exam room or issuing new clinical policies won’t move the needle enough. Changing behavior is hard. We have to look at the social and behavioral fabric in which antibiotic prescribing decisions take place.
One reason is that humans don’t…