by Geri Lynn Baumblatt, MA & Keith Joseph, PhD
A few months ago, Keith (ft. left) had a very mild pain in his cheek on the left side. It would have been easy to ignore, but this felt different.
He found out his tooth was cracked and should come out. He opted to replace it with an implant. The specialist needs to put a post in and his dentist will put a crown on the post -- not good as new, but close.
Two weeks before his appointment he received some information. It does a pretty good job explaining the implant procedure, and four medications have been prescribed: two for pain, a mouthwash, and the fourth is an antibiotic. The instructions are clear:
You need to begin taking this antibiotic the day of the procedure and continue taking it as prescribed until it is all gone.
Like a growing number of people, Keith worries about antibiotic overuse for himself and about problems with resistance. In fact, we both just attended the Lown conference in Chicago, where the focus is right care: appropriate care and preventing overuse. At the conference, a team from the Icahn School of Medicine at Mount Sinai* presented a strategy they studied in the hospital to have physicians ask with each patient: Does this patient still need labs? The strategy reduced routine labs in clinically stable patients. Taking a moment to step back and question the default and the true need.
Both in the form Keith received and with his dentist, there was no discussion about why antibiotics are needed beforehand, let alone the potential dangers of taking too many antibiotics over time. Like in Don't Forget the Why, the rationale, and in this case the potential harms aren’t discussed.
As Keith said, “I can make things up in my brain, but I’m not sure if it’s true or not.” He’d like to know (and he knows many aren’t like him and won’t ask):
1. How likely is an infection?
2. What else are they doing and what else can he do to help prevent an infection?
3. How serious is it if he does get an infection?
4. Could his body fight off an infection on it’s own - or is an antibiotic always needed?
5. Could he take the script home with him, and if he developed signs of infection, could he take the antibiotics then? Would that be just as effective and let me avoid taking them unnecessarily?
Giving instructions is a position of power; but proactively asking ourselves and colleagues whether a treatment or test is needed can help reduce overutilization. Then explaining why and having more of a shared decision making conversation can also help ensure if it’s appropriate and means patients are less likely to go home, as Keith did, with unanswered questions.
*Surafel Tsega @drtsega, Michelle O’Connor, Colin Iberti, and Hyung (Harry) Cho
Keith Joseph, PhD is a research, writer and instructor. He was a college professor of mathematics and computing for 15 years. He then worked at a small aerospace company: Computer Technology Associates, then for Pacific Bell and Wells Fargo. In 2013 he began work on a new project: Becoming a Smarter Patient (BASP). He believes patients can help create a more productive partnership with clinicians. firstname.lastname@example.org
Geri Lynn Baumblatt, MA, is the Executive Director of Patient Engagement at Emmi where she oversees the creation of multimedia patient engagement, education, shared decision-making, and behavior change Emmi programs and interactive phone calls. She hosts an annual October Health Literacy Month blog series for Engaging the Patient. She serves as an Editorial Board member for the Journal of Patient Experience. Emmi Solutions works with decision scientists, behavior change experts, patients, and clinicians; they draw on their research and experience to create content that helps patients engage in their care. Follow Geri on Twitter @GeriLynn.