Dishonesty all around
The scale of the deception raises issues, particularly regarding the potential for improperly obtained antibiotics to fuel the growth of antibiotic-resistant infections. It’s widely accepted that misuse and excessive use of antibiotics can lead to the emergence and spread of drug resistance. This week, the Centers for Disease Control and Prevention released an updated report detailing antimicrobial resistance threats, which revealed that drug-resistant bacteria and fungi are responsible for 9.7 million infections and 50,800 deaths annually in the United States.
In the accompanying commentary, Linder expressed concern over the possible “erosion of trust” between doctors and patients. While he acknowledged the importance of drug resistance, he suggested that, for most patients in typical clinical situations, the emergence of drug resistance is likely not a significant concern.
Linder posed a crucial question for doctors: “Is this prescription more likely to help my patient or harm them?” The likely answer is harm; unnecessary antibiotics offer no real benefits and come with risks such as adverse reactions, allergies, and disruption to healthy microbiomes, which can pave the way for opportunistic pathogens like Clostridioides difficile, identified as a “serious threat” in the CDC’s updated report.
For diagnoses that do not warrant antibiotics, Linder argued that prescribing them is not only medically incorrect but could also be seen as a form of dishonesty or lying, primarily to placate the patient. He referenced philosopher Sissela Bok, who had extensively examined the issue of lying, particularly in the context of obtaining antibiotics. In 1978, Bok noted that antibiotics were sometimes used as placebos, and many parents started believing that they needed to request antibiotic prescriptions every time their child had a fever or a cold. Bok contended that when healthcare providers prescribe medications that are more harmful than beneficial, such “practices lacking in candor” threaten to undermine “the entire institution of medicine.”
Linder concluded by emphasizing that “Clinicians are obligated to act in the best interests of their patients, even when patients are hoping for something different, even if they don’t like the advice, or even if they are not entirely truthful about their symptoms.”
Thorpe and colleagues wrapped up with a suggestion to tackle the root causes of patients’ dishonesty, noting that “strategies to enhance communication regarding antibiotics are essential for addressing patient concerns, fostering understanding of appropriate antibiotic use, and reinforcing patient-clinician relationships.”
