#AbxScore

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I stumbled across an article circulating around the twitterverse today – the comfortingly titled “Antibiotic Resistance Will Mean the End of Just About Everything As We Know It” – and I was left with a gnawing unease about my antibiotic prescribing habits.

Until now, I think I’ve tended to cut myself too much slack. I’m already SO much more conservative with prescribing than other providers I work with – so the story I tell myself goes – and most definitely moreso than these patients’ providers back at home who prescribe successive Z-packs over the phone from 3 states away, right? And don’t get me started on antibiotics being available over-the-counter everywhere else in the world. So really, if a particularly insistent patient comes to see me and presents some halfway decent story about their miserable and worsening nasal congestion, am I the absolute worst person in the world if I cave from time to time?

The danger of this line of thinking is the same pattern that led me to gain back half my baby weight in the 2 years after kid #1 was born, one delicious pastry at a time. If one ice cream sandwich is good, two is better, right? And it’d be a serious tragedy if the remnants of that fettucine alfredo was just thrown away LIKE TRASH simply because no one was courageous enough to finish it off.

But after a particularly contentious meeting with a clinic scale, I decided to make a change. I downloaded one of those calorie-counting apps, where it calculates your daily caloric limit, and then you enter every bite of nutrition that passes your lips. Super fun time! But seriously, IT WORKED. It kept me honest. Before grabbing justonemorecookie, I’d think about how I’d have to enter it into this dumb little app, and see the number of cookies consumed staring me in the face. Blergh. Somehow the cookie didn’t look so irresistible anymore.

So I’m just kicking this idea around here, but what if we all (we all = MDs/DOs/NPs/PAs working in primary care, urgent care, retail clinics, etc) started doing the same thing with our antibiotic prescribing?

It could be like a game. I hear these hashtag things are popular, right? So what if we started posting our daily #AntibioticScore? And by score I mean numeric value, as well as SCORE! Yeah, brah!

Actually, #AntibioticScore is kind of long. And my fingers trip up over all the i’s and the t’s and whatnot. So let’s abbreviate, shall we?

#AbxScore = # of questionable antibiotic prescriptions NOT given due to spectacular patient-centered education and counseling / total # of questionable antibiotic prescriptions possible.

Today, I saw 3 patients with vague-ish URI symptoms who were here for – let’s face it – antibiotics. At the end of each visit, they all left agreeing with me that they really didn’t need antibiotics after all. So today’s score would be 3/3, or 100%! GO ME. (It is likely not a coincidence that today is the day I decided to start tracking myself. It’s like deciding you’re going to commit to wearing that FitBit the day that you happen to go hiking and kickboxing and cycling, all in one exhausting 24-hour period.)

Now, your daily #AbxScore doesn’t include legitimate antibiotic prescriptions. I also saw two cases of strep throat, and one patient with a UTI, but these don’t get included in my #AbxScore because, um, they clearly needed antibiotics. I get that there are plenty of real, valid indications for antibiotics. I’m not insane, people.

But if you’re even thinking about using the diagnosis code for an undifferentiated “upper respiratory infection (URI)” at the end of your note – even if you’re more likely to enter the more specific-sounding “sinusitis” or “bronchitis” to feel justified about giving that Augmentin rx – that visit gets entered into the #AbxScore. Which you then post on Facebook or Twitter or your bulletin board at home or whatever, allowing your peers (or children, or pet ferret, or you looking back at yourself in the mirror) to congratulate you on your spectacular antibiotic stewardship.

Now, this is honor system only, obvs. Especially because there’s, um, no actual prize. Except of course SAVING THE WORLD FROM A POST-ANTIBIOTIC FUTURE. (One self-resolving cold at a time.)

Who’s with me?

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5 thoughts on “#AbxScore

  1. I have had to (TWICE!) convince my doc (or rather, doc’s assistant when he calls me back per my doc) that instead of just going straight to the antibiotics for a possible stubborn UTI and abdominal discomfort we should A) wait to get the lab culture back which supposedly would give us more information on the bacteria I had which would allow the possibility of selecting a more specific antibiotic, and B) after taking said antibiotics things weren’t exactly cleared up and the urine test results were a bit perplexing, instead of going for round 2 of antibiotics to blast my delicate system again we should move forward with the abdominal ultrasound FIRST as we discussed (meaning my doc suggested the ultrasound to me originally at my appointment, the doc’s assistant had no idea what I was talking about). I understand not wanting to prescribe expensive tests willy-nilly either, but I have insurance and if there is some sketchy issue going on it seems more responsible to try to figure out what that is instead of constantly pushing the antibiotics… though, of course, as just a patient with no knowledge of the system I may be wrong….

    • CC: you sound perfectly logical to me! Please continue to discuss these things directly with your provider, and don’t be afraid of feeling like you don’t know what you’re talking about- no one expects you to understand if you don’t do this stuff for a living, but your provider should be able to explain why they’re recommending one treatment course or another (be it medication or testing, etc.). Keep up advocating for yourself. This doesn’t mean you have to know what treatments to request (that’s the whole point in going to a medical provider who has training in this stuff). But it means you can keep asking questions or expressing to your provider if you are not entirely convinced about a certain treatment plan. If the provider is worth their salt, they will respond by discussing the options, their recommendations, and a reasonable treatment plan with you, such that you are both satisfied with the outcome.

      [I’ve run into more-senior providers who instructed me “just give them the antibiotic, you don’t have the time to deal with ongoing follow up.” !! Really?? How crappy is that advice? Needless to say, I did not follow it.]

      Bottom line, if you say something like “look, is there something else we can try besides another course of antibiotics? Because I’m not entirely comfortable with that option- what else can we do?” You should get a better response from your provider (I hope- lord knows there are plenty of crappy providers out there, and we all have our less-than-inspired days-). You can always inquire about being referred to a specialist, too.

      Very best of health to you-

  2. Pingback: #AbxScore Week 2 | Love and LadyBits

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