Antibiotics are miraculous. Prior to the discovery of penicillin in 1928, the average life expectancy was 47 and the most common causes of death were infectious diseases. By the 1950s, when antibiotics were purified and widely put to use, our life expectancy jumped to 78, and infections were no longer the largest killers looming over us.
For as powerful as they are, however, antibiotics are too often treated as trivial. That is the theme of this year’s National Antibiotics Week, which strives to warn doctors and patients alike about the way overprescribing and overuse of antibiotics has led to dangerous antibiotic-resistant diseases, allergic reactions, diarrhea and other complications, including deaths.
The advent of telehealth seems to have exacerbated the problem. Studies have found that 52% of telehealth visits result in antibiotic prescriptions, compared to 42% of urgent care visits and 31% of primary care office visits.
I’m reminded of a passage my colleague, Dr. Blake McKinney wrote a few years back in which he noted that “Legacy telehealth companies rely on fee-for-service phone and video conferencing that create an environment in which doctors are incentivized to see patients faster, which often leads to antibiotics being overprescribed. Without the luxury of time, or relationships, physicians in these types of telehealth practices have every motivation to overprescribe and over-refer.”
I am proud to say that we have some of the lowest rates of medication prescription among any telehealth company, and I believe that is because we’ve created a way to align a doctor’s business model with a patient’s best interest.
Many telehealth services — especially those with video modalities and physicians compensated by the number of completed encounters — are typically limited to a 15-minute or less window for consultations and may default to writing a prescription “just in case” or because they feel pressured from the patient to “get something” for the cost of the visit.
Because our physicians are paid an hourly salary, we can take the time to have longer consultations to create rapport and build trust with our patients, uncover the larger patient story, and truly understand whether a prescription is necessary and/or indicated.
We are able to apply an evidenced-based and judicious approach to care – otherwise known as “wait and see” – because we are actually waiting and seeing. CirrusMD considers a seven-day window as a single encounter. This allows us to take the needed time with a patient to see if a particular course of action is working, before we suggest a prescription. Often there are non-antibiotic recommendations that actually work better, especially when there is a low suspicion that bacteria as a cause of a condition.
In contrast to what “awareness” must have looked like nearly 100 years ago, the main messages behind this National Antibiotics Awareness Week are all about the dangers of overuse, the rise of antibiotic-resistant bacteria and the increase in allergic and other negative reactions.
As a physician at CirrusMD, I would add one more message to the list: The importance of taking our time and partnering with our patients. While antibiotics are only sometimes the answer, careful thought and deep listening can never be overprescribed.