Iowa Specialty Hospital

Making the Rounds

March 29, 2018

The Pendulum

For over a decade we (healthcare providers) have been admonished to treat pain. Now we have an opioid crisis. For the same decade, we have been overprescribing antibiotics as well. That was usually the best way to keep the mother of a child with a viral illness happy because "reassurance" wasn't good enough. They weren't going to be happy if they didn't go home with antibiotics, even if they are useless against viruses. Due to this practice, we have created resistant bacteria (superbugs).

What we were actually taught in medical school was that pain has a purpose. It helps to diagnose. That is why we must examine and find answers before starting analgesics. The goal is to treat the CAUSE of the pain while providing comfort to the patient. We were also taught to be judicious with antibiotics; to know what we're treating and its sensitivity before prescribing antimicrobials. Somewhere between "Press-Ganey" and wanting to go back to sleep we have lost that motivation.

Fortunately, we are starting to do the right thing again. Thankfully the opioid guardianship and antimicrobial stewardship programs have been initiated. The pendulum to which I refer is making its way back to the middle. It will not be easy. Patients expect certain things and providers are going to have to stand firm and follow evidence based practice in the face of unspoken expectations. We are going to need grace from everyone involved. From providers who are going to have to use excellent customer service skills and extra time to explain a course of treatment to patients who will need to be better informed that need to trust more as things change, and finally to administrators who may see patient satisfaction scores temporarily drop. Ultimately, we want what's best for the patient. Similar to many other aspects of life, what is best is not always what is easiest or most popular.

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