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Antibiotic Overuse: Why We Don't Care

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This week in the news, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating "so-called superbugs." In this USA Today article (from which the graphic above was taken), it states that superbugs "cause at least 2 million infections and 23,000 deaths each year."

You know who is causing the problem, right? It's doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you have the courage to dig deeper, Antibiotic Overuse is just a symptom of our broken health care system, unrealistic high expectations from society, and paralyzed government bureaucracy. Consider these factors:

  • Where's the Tort Reform? In the United States, it is our right to sue anyone we want to at any time and for any reason. Many people yell at hospitals for using too powerful antibiotics and this is the cause of resistance. "Antibiotic Stewardship Programs" are being put forth to limit hospital antibiotic use. Will this really work? If I have a patient pass away from an infection, and the attorney asks me why I didn't use X antibiotic and I say it's because of the "Antibiotic Stewardship Program," of course I will be labelled as someone who is looking more out for the hospital and not for the patient. My career will be over. Why risk that? I'm gonna prescribe that antibiotic. Don't blame me. Fix the legal system, and then talk to me.

  • Where is Choosing Wisely? The Choosing Wisely campaign is designed to educate and make physicians order less "unnecessary" tests. It's no secret that I'm skeptical about this (read this post). I challenge the campaign to add appropriate use of antibiotics to their recommendations. Will they? Let's see.

  • Yes, I get paid when you're sick. The broken payment system has been written about many times, and illustrated in movies like Escape Fire. I would rather be paid for high quality care, and not high volume of patients coming through my door. Many docs believe coming in for an office visit is quid pro quo for then giving an antibiotic. Or, in more awkward fashion, see the next item...
  • I paid a $30 co-pay and didn't get an antibiotic? For the foreseeable future, there will be the expectation of antibiotic since, "I had to pay such a high copay to see you." Or, "next time, I'll take my business elsewhere." Or, "it doesn't matter what you do, I'll get my antibiotic here or at the urgent care." Which leads to the next item...

  • Where's that rating sheet? Many patients know that patient satisfaction surveys factor into physician payment schemes. It has been written about many times that "The Customer Is Always Right" is maybe good business, but sometimes bad medicine. Check out the KevinMD site for multiple essays on this including this one,  this one, this one. and this one.

  • You're not making me get a flu shot. I already ranted in a previous post, so, I won't do that here. The unintended consequence of not immunizing is more and more use of antibiotics and antiviral meds - which, of course, will lead to more resistance. Just imagine how much Antibiotic Resistance could be slowed down if everyone received their recommended immunizations. Mind blowing, isn't it?

  • Animals also get antibiotics. I only learned about this a few years ago. But, this is an easy fix, right? Here's a quote from the USA Today article, "In 2012, the FDA asked food producers to stop putting antibiotics in animal feed to promote growth, but the guidelines do not have the force of law." So, animals and humans will continue to get their antibiotics.

When it comes down to it, the medical issue of Antibiotic Resistance is like the political issues of trying to solve Mass Shootings, Government Spending, and Immigration. We all know what the problems are. But, there is no real emotional or political will to actually solve the problem. So, we will continue to have mass shootings, we will continue to raise the debt limit, we will continue to allow illegal/undocumented people in this country, and, oh yeah, we will continue to have Antibiotic Resistance. Go ahead. Tell me where I'm wrong here...

Addendum: For clarification, I did hear back from the ABIM Foundation this afternoon on a number of fronts. In addition to their comment below, which I appreciate, they also had the following tweets. Thank you for your response, and I ask the readers of this essay to also note their input.

Why Immunizations Matter

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One of the reasons I love social media is that it keeps me up to date on breaking news stories. Here are two stories that came through my social media channels in just a few hours tonight. Both of these have to do with immunizations, which, of course, is a Healthcare and Social Media hot topic, especially among pediatricians.

"U.S. Measles Cases in 2013 May Be The Most In 17 Years ," was posted on CNN earlier today (photo credit from this article). In case you're not familiar, measles is a highly contagious respiratory disease caused by a virus. According to the Centers of Disease Control, there have been 159 cases from January 1 through August 24. If this keeps up, this will be a record year of cases. According to this article...

Nearly two-thirds of the reported cases happened in three outbreaks in communities where many people don't vaccinate their children for religious or philosophical reasons.

Some parents have been hesitant on childhood immunizations for many years, but the controversy was ramped up in 1998, when a study was released stating that the measles vaccine was linked to autism. The press and many celebrities got on board to tell people to avoid vaccines.

When I was in residency in the early 2000s, it was very difficult for me to convince parents to give their kids not only the MMR vaccine, but any vaccines. This controversial research paper was partially retracted in 2004 and labelled totally inaccurate (meaning the study lied) in 2010. But, by then, the damage was done. To this day, many parents still refuse immunizations for their children. 

Fast forward to today's report. Twitter was lighting up today with medical professionals and the general public upset with people who do not vaccinate their children. 1998 was pre-social media the way that we know it today. The mainstream media, celebrities, and vaccine opponents went unchecked and the lies perpetuated. These days, you see tweets below to spread the correct information...

 

The second story I'll quickly mention is "Whooping Cough Reaches Epidemic Level In Texas," from Reuters. According to the article, the number of whooping cough (aka Pertussis) could hit a 50-year high. Pertussis is a highly contagious bacterial disease that can last weeks, especially with severe coughing fits. Pertussis can be prevented with vaccination. The piece does not go into why state officials believe cases are increased. Some on social media have stated that this epidemic was also caused by vaccine refusal.

I believe both of these infection stories underscore the importance of childhood immunizations. Even as I write this blog post, I'm receiving e-mail messages and direct messages on social media saying things like, "Well, if there were only safe immunizations, then I could get my children vaccinated." Really? That's what you have to say for yourself?

Whether it be childhood immunizations, adult immunizations, flu shots, statin medications, or whatever - until the fear of the disease, illness, or death - until this can overcome the unrealistic expectation of zero side effects, tragedies like preventable illness and preventable mortality will continue... 

E-Cigarettes: Good for adults, Bad for kids

Are electronic cigarettes, e-cigarettes, good or bad? There have been two huge stories in the past week, which may be seen as conflicting and confusing. First, the good news. Last week, the research journal "The Lancet" showed that Electronic Cigarettes are effective in helping adults stop smoking. How effective? About as effective as the nicotine patch. Of course, more research is needed in this area, but this is a positive step, right?

Now, the bad news. Also last week, a study from the Centers for Disease Control showed that E-Cigarette Use More Than Doubled among US Middle School and High School Students. I recommend you check out leading pediatrician social media journalists Dr. Wendy Sue Swanson and Dr. Claire McCarthy on their great essays on the topic. (BTW, where are the Family Physician social media leaders on this topic? We care for kids, too, right? Get out there on social media and tell people about it!)

But, what's the problem? Kids cannot purchase real cigarettes. So, that means they cannot purchase e-cigarettes, right? WRONG! My home state of Ohio currently allows minors to purchase e-cigs, at least for now, according to this Dayton Daily News article. That's gotta change. Currently ONLY about a dozen states prohibit minors from purchasing.

In the video above, the news report from last weekend outlines the dangers of e-cigarette use, especially in children. Many editorials have been written, including this one from Newsday, asking states and the federal government to increase regulation to prohibit minors from purchasing e-cigarettes, just like prohibiting purchase of "real" cigarettes.

Don't misunderstand. I don't want to ban all e-cigarettes. I have a lot of stories from patients and stories from friends saying how much e-cigarettes have helped them cut back and/or eliminate the use of real cigarettes. The initial data from The Lancet study is hopeful, and reinforces the anecdotal stories that I have from patients and from friends.

My issue is preventing children from access to electronic cigarettes. There is a window of opportunity (legally) for tobacco companies to expose children to the nicotine experience. And, I think that the health community, as well as the general public, have to educate ourselves on this subject, and get our lawmakers to do the right thing...

My Experience at 9/11 Memorial

September 11, 2001 was a significant day in my life. And, even without social media (as we know it at the time), I felt connected somehow to the events in New York City. I saw the people walking across the Queensboro Bridge trying to get home. At the beginning of last week's podcast, I shared what happened to me on 9/11/01. Back in 2008, I wrote this blog post about it, and even sparked a video response below from our pal Crzegrl.

As I mentioned in a previous post, I was in New York City last week with my family. The one place I was both most anxious about and most looking forward to was the National September 11 Memorial at the World Trade Center site. 

As you approach the entrance to the memorial, you cannot help but look up and see Freedom Tower, or as they refer to it now, One World Trade Center. It's an eerie feeling I had when entering the site. The first thing you notice is the many security check points that you have to go through before entering the memorial plaza. The second thing you notice is that even with all these people around you, the silence is deafening.

As you enter the memorial plaza, the South Memorial Pool is in front of you. I've seen it on television, but you do not have a gauge of the size of the pool until you physically walk around it. In addition, the sound of the waterfalls of the pool is so loud, that it drowns out the city noises and the people talking around the pool. As you look up from the pool, you see Freedom Tower, and the emotion overcomes you. 

As I walked around the rest of the memorial plaza, I saw young children being talked to by their parents and grandparents about what happened here. In addition, on some of the names, I saw one flower placed in the letters of the name. This made me think of all the families affected. I shared my experience in real time on twitter. My tweets are at the bottom of this post. 

In the video above, you see and hear the segment from last week's podcast where I share my experience at the National September 11 Memorial. You can check out the entire audio podcast in the player above, and you can download the episode here. Never Forget the events that happened on September 11, 2001....

Do Online Confessions Matter?

This Columbus, Ohio story has now went nationwide. First reported by the  Columbus Dispatch last week, the video states, "My name is Matthew Cordle and on June 22, 2013, I hit and killed Vincent Canzani. This video will act as my confession." If you haven't seen it yet, check out the video above.

The criminal case is yet to be determined. But, what interests me, at this point, is the media reaction to this video. As of this posting, there have been 1.1 million views (probably mostly news reporters) of this video. In multiple articles, from nbcnews, SF chronicle, LA times, and the guardian, the coverage has been manly positive - even giving sympathy to Cordle, because, in the video, he's giving a message of Do Not Drink and Drive.

But hold on, says Angela Canzani, the daughter of the man who was killed by this drunk driver. In an article from the New York Daily News, she says Cordle "would not cooperate with the police or with the insurance company" for the past three months. She also states that he just wants a "lighter sentence."

How effective are Online Confessions? Do they even matter? I guess the first task is to make sure they are real. Also last week, there was an online confession from the site PostSecret that was making the media rounds. According to an article from CNN, there was a message on the site confessing to the killing of a woman. A few days later, police stated that the confession was a hoax, from this cbsnews story.

In this age of social media where you can say anything and post anything, whether you're Matthew Cordle, or Paula Deen, or Anthony Weiner, or (insert your celebrity or politician here), there will be consumers out there. Will it have a big impact on your professional or personal life? I guess we will be the judge of that...

Podcast Anniversary

At the end of last month, I celebrated six years of podcasting. It's been so much fun for me to find a medium to express my thoughts and to meet so many great people. For example, in the video above, I received a phone call from Greg Friese who is part of the powerful EMS podcasting and social media community. I wouldn't have ever gotten to know the EMS community without social media. 

Thanks to all of you out there who have supported me through the years in all of my social media projects, and even though my brief social media break. You can listen to the anniversary podcast in the player above. Or you can download the entire audio podcast here and listen anytime. Enjoy! 

Dear Ariel Castro

About four hours ago, you took the cowardly step of taking your own life around 9:20pm ET. Over the course of ten years, you kidnapped and tortured Amanda Berry, Gina DeJesus, and Michelle Knight in that Seymour Avenue neighborhood. Thanks to people like Charles Ramsey, your secret was revealed, and you were in the midst of a 1000 year sentence.  

In your last desperate move, you thought you were still in control by hanging yourself in your cell tonight. Everyone remembers that creepy speech you gave during your sentencing blaming everyone but yourself. Suffering the consequences of your crime does not stop with your suicide. Your final judgement is to come and justice will be served. Michelle is right when she said during your sentencing, "Now your hell is just beginning. I will overcome all that happened, but you're going to face hell for eternity."

History will quickly forget who you are and you will be a distant memory. The best end to this story will be following the lives of Amanda, Gina, and Michelle as they put time and distance away from these horrific events. As seen in the video above, we are already starting to see the beginning of their recovery. The best revenge will be seeing these young women help others avoid people like you, so tragedies like this will never happen again...

 

Weekend in NYC

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I'm usually working most holidays (imagine that). But, I'm spending this Labor Day holiday weekend in New York City with the family. It's always fun spending time with the family, but add the elements of New York City, Times Square, and the Theater District - well, things get a little more interesting.

My facebook and twitter friends have been following along, but here are some random impressions from the past few days from specific places. In addition, I'll post pics soon, but enjoy the commentary below!

Bus Trip: We took a bus instead of flying in. I'm glad that I didn't have to worry about things like parking or getting/to from airport if we had to fly, etc. Even though their website is under construction, 20th Century Tours in NE Ohio did a nice job. Their temporary website is here. 

Little Italy: In my previous trips to NYC, I never toured this part of town. Of course, this area of town is made for tourists, but it was fun to walk around. Had lunch at Cafe Napoli which is in the heart of Little Italy. Good food and good people watching from outdoor seating. Also went to Ferrara Bakery and had some great treats!

The Edison Hotel: This hotel is in the heart of the Theater District and just steps from Times Square. Thanks to my sister in law's expertise, we were able to obtain the recently renovated rooms. Kudos to the hotel staff for their great service, hospitality, and professionalism. Well done!

St Patrick Cathedral: I've seen this on television in the past, but was never there in person. The church building is currently under renovation, but what we saw was still beautiful. What's cool here is that they encourage you to follow the church on twitter and to check in on facebook. What other Catholic churches do that? Very few, I would guess.

Hard Rock Cafe NYC: I know people will yell at me for going to this tourist trap, but I enjoy going here. I've been to other locations including Cleveland (Duh), Orlando, and Key West. Always good atmosphere and I always have fun there.

Strawberry Fields Memorial: Part of our bus tour took us around the city. One of the stops was The Dakota Building where John Lennon lived and was assassinated. In addition, we went across the street to the section of Central Park called Strawberry Fields which is a memorial to Lennon. Was weird just walking around that part of the park. 

Brazilian Day NYC: September 1, 2013 was designated Brazilian Day in New York City. A big part of 6th Avenue (usually 6 lanes of traffic) was closed off and there was a street fair and festival there. The coolest thing I got to see was an all female drumming group called "Batala NYC." These women rock!

M&M World NYC: Of course, I could not be in Times Square without stopping at the M&M store. I have no idea what it is about my interest/obsession with M&Ms. It's always fun seeing all the different colors that exist only at the retail stores (see pic above).

Kinky Boots: This musical that was part of the travel package. And, I admit that I knew nothing about this show. When I arrived here, I did some research and found out that it had won a lot of awards, and some of my friends have told me that it's a great show. I'm not really into Broadway shows, but this was an entertaining 2 hours. Even for uncultured me, I would recommend this musical to anyone - really.

John's Pizzeria: There has to be hundreds of pizza places in the New York area. My sister-in-law recommended this one, and it didn't disappoint. We heard that the Times Square location we were at was formerly a church, and now it makes great pizza. 

Times Square: What else can you say other than it's tourists and people dressed up in everything from the Statue of Liberty to superheros to cartoon characters to everything in between. If you have never been there, going at night time is so much different than going in the daytime. I did my very first instagram post from there. NYC police were everywhere and I felt very safe walking around and making fun of people LOL

9/11 Memorial: This will be the last stop before going home today. Probably warrants an entire post itself. We'll see...

Primary Care Advocacy By Students

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The Future of Family Medicine and Primary Care is Bright! This weekend, in the Boston area, was the Gregg Stracks Leadership Summit organized by Primary Care Progress. Pictured above is Dr. Andrew Morris-Singer who is the Founder of Primary Care Progress.

Few people are born leaders. In this two day conference, participants are taught advocacy leadership and organizing skills that will be applied back home in their communities. Yesterday, featured speaker Marshall Ganz shared an organizing model using the phrases, "Story of Self," "Story of Us," and "Story of Now." Claudia Fegan was also a featured speaker yesterday and a participant tweeted out from her talk, "It is our responsibility, as primary care providers, to fight for our patients."

A Primary Care advocacy campaign is to be announced at the conference today. Last year, Primary Care Progress conducted a very effective photo social media campaign called "Voices For Primary Care." I think social media will play a major role in the upcoming Primary Care advocacy campaign.

I hear all the time that students are too overwhelmed and too busy to think about anything else other than getting through the curriculum. What I saw this weekend are many talented young people who arrived with passion for Primary Care and a Passion for taking care of patients in their communities. These students will leave here with Leadership skills to pass on to their friends and colleagues at home. This advocacy momentum will continue to build to bring out change at the local level, state level, and eventual national level. 

My thanks to Primary Care Progress for the invitation attend this year's Leadership Summit. I invite you to check out my previous posts that had Tweets from Day One and Pics from Day One. Also check out today's events using the twitter hashtag #PCPSummit2013. More excitement to be announced soon by the organization...

 

Pics from #PCPSummit2013

Photos from Day One of the Primary Care Progress Leadership Summit In Boston. Most of the participants are trainees including medical students, nursing students, NP/PA students and others. Apologizes if I left out some of the people from the group photos, and other mistakes I made. Also check out the previous post with tweets from Day One...