Ratings, Reviews, Life, and Death
The first installment in an ongoing discussion…
As a registered nurse in an urgent care setting, I am now more aware than ever before of the overuse of antibiotics. In my orthopedic/trauma background, antibiotic use was rarely questioned and seemed very adequate when related to the major surgical procedures and/or traumatic injuries my patients were dealing with. We used antibiotics as a preventative measure, antibiotics during procedures, and antibiotics post-procedures to cover the broadest spectrum possible. To cover side effects, we had more medications — some to coat stomachs, some to regulate bodily wastes, and the list goes on.
Now, I work with a population of all ages in a more outpatient, walk-in setting. More often than not, individuals seek advanced medical treatment for a typical sore throat, a headache, a backache, or an infected tooth (that would be best served by a dentist, but that’s another post for another day). In many cases, an OTC (over the counter) medication would be sufficient treatment, but for various reasons some individuals seek Urgent Care treatment prior to consulting a store shelf or a home medicine cabinet. Sometimes the MDs I work with will prescribe a simple regimen of Ibuprofen/Tylenol with increased fluids by mouth and adequate rest. However, patient satisfaction is becoming increasingly paramount in the healthcare setting and is tied to reimbursement, rating scores, staff salary, hiring freezes, and can create a cascade of negative consequences for negative ratings. These days, it seems over prescribing to treat a viral infection is also tied to patient satisfaction, as patients don’t feel like they “got their money’s worth” if not treated with a round of prescription strength medications including an antibiotic and a pain medication. MDs are pressured to achieve positive review/rating scores from all patient populations served, and while I’m not insinuating that anyone is practicing bad medicine, I do know that antibiotics are often given against better judgement. Thus, antibiotics are overused.
The other big problem is that these individuals are then noncompliant with antibiotic prescriptions despite education that all pills need to be taken, not just until the body is feeling better, and not one here and there.
Now we have overuse and noncompliance, a deadly combination, especially when it comes to antibiotics.
How do we fix this? Well, I know there is no one answer and no easy way, typical of true dilemmas. But the first thing we can do is realize that even in our fast-paced society and important daily lives, sometimes we just have to take a sick day. Don’t expose everyone you know to your germs, don’t push yourself to complete the to-do list when you’re ill, and try your best to do what the doctor said last time: take Tylenol/Motrin for fever and discomfort, drink lots of fluids, open your sinuses in a hot shower or over a cup of steamy green tea, and get some rest. Pull up a box of tissues and wash your hands often. These are all good places to start, and yes — sometimes this is truly all it takes.
Now, I get it. Sometimes we all need more than home remedies and OTC fixes and many individuals have a complex medical history that requires more intense early intervention. That’s why we’re here: MDs, RNs, hospitals, doctors’ offices, and med stops. Come and see us. But please, don’t play Dr. Google or Dr. My-Mom-Told-Me-To-Ask-For-This—while you do know your own body, you are likely not a medical expert. Don’t feel “cheated” if you don’t leave with an antibiotic. Do know that there is a bigger threat looming, and one day you might need an antibiotic to keep you ALIVE, rather than to simply speed the disappearance of a pesky sore throat. If you need more convincing, read McKenna’s take on the future to learn more about the reality we might be facing sooner than later.
Lastly, America has a problem with placing so much value on customer satisfaction. Like you, I enjoy good service at a restaurant, a store, and more. And there is never a good reason for an employee — healthcare certainly included — to treat you with outright disrespect, but satisfaction should not be so closely tied to healthcare provision. For example, this consultant tries to make a connection between hospitals and The Ritz-Carlton…and he isn’t even joking. The practice of medicine is a complex, sticky, and often unpleasant (by nature) world that cannot be captured by a few questions concerning the overall satisfaction of an experience. This isn’t a competition. Except that now it is, and appropriate use of antibiotics is just one example of how the balancing act of treating and pleasing is getting harder by the day.
