Dishonesty everywhere
Given the scale of the deception, the findings raise concerns that illegally obtained antibiotics could contribute to the rise in antibiotic-resistant infections. The abuse and overuse of antibiotics is known to promote the development and spread of drug resistance. This week, the Centers for Disease Control and Prevention released an updated report on antimicrobial resistance threats, revealing that drug-resistant bacteria and fungi now cause 9.7 million infections and 50,800 deaths each year in the United States.
But in the accompanying commentary, Linder said an even more concerning consequence could be the “erosion of trust” between clinicians and patients. Linder acknowledged that drug resistance is a concern, but said that, on an individual patient basis, in most clinical circumstances the development of drug resistance is “probably immaterial.”
For Linder, the most pertinent question doctors face is: “Is this prescription more likely to help my patient or harm them?” The answer is that it is more likely to hurt; unnecessary antibiotics provide no benefit, but pose a risk of adverse events, allergic reactions, and disruption of healthy microbiomes, which can open the door to opportunistic pathogens, such as Clostridioides difficile (which is classified as a “serious threat” in the CDC’s recently updated Antimicrobial Resistance Threat Report.)
“For these antibiotic-inappropriate diagnoses, prescribing antibiotics is medically incorrect and could itself be considered a form of dishonesty or lying primarily intended to appease the patient,” Linder wrote. This dishonesty is corrosive, he said, citing philosopher Sissela Bok, who has written extensively about lying and, more specifically, lying to obtain antibiotics. In 1978, Bok noted that antibiotics are “sometimes used as placebos” and that many parents “come to believe that they must ask for a prescription for antibiotics every time their child has a fever or cold.” But Bok argued that when clinicians prescribe drugs that are more likely to harm than help, such “lack of candour” practices threaten “the entire medical institution.”
Linder concludes by reminding readers that “clinicians’ obligation is to act in the best interests of patients, even if patients hope we do something different, even if patients don’t like it, or even if patients lie about their symptoms.”
Thorpe and colleagues, meanwhile, conclude with a call to address why patients lie in the first place, writing: “Strategies to improve communication about antibiotics are needed to address patient concerns, support understanding of appropriate antibiotic use, and strengthen patient-clinician relationships.” »
Gn Health
