AAFP's Acute Bronchitis Handout
In the December issue of American Family Physician is a nice short article on Acute Bronchitis. With the article is an updated patient handout. The original (now over 10 years old) was something I printed out for probably thousands of my patients over the years - and I successfully used it to help educate patients (also medical students & residents) that one needn't (shouldn't) treat everyone who is coughing with antibiotics.
This is of course a familiar topic to those of you who have been reading my blog for the past 11 years .. so to some degree I know that I am preaching to the choir - but it is clear that physicians still struggle with this problem. This recent study looked at prescribing practices - and gave physicians tools to employ when they felt pressured to prescribe. It's challenging situation: physicians know that the patients would most likely do just as well without the antibiotic - but in many cases, they are pressured by the patient to do so anyway.
This is not unlike many relationships between a business and a customer. Successful architects, designers, software companies, computer companies, car companies and electronics companies deeply understand the core principles of giving their customers with what they NEED rather than what they ask for. This is the task of a product manger. In many ways - physicians are product managers for the core product that we provide to our customers: optimal health. Take a look at this free book (pdf) on product management if it's new to you. You'll need to translate from CorporateSpeak to terms that make sense in healthcare.
So - do patients NEED antibiotics for bronchitis? In general - No. So why do over 1/2 of patients who seek care for a cough get antibiotics? I'd argue that it's because physicians are rotten product managers. Indeed - if we just change the words we use to describe the diagnosis - demand for the antibiotic decreases significantly. Is this Marketing? Product Management? Of course it is. We alter demand for a product - based on how we describe it. How is that different from marketing cars? vitamins?
Yes - of course - the best interest of the patient is what is at stake here. We're not talking about their listening pleasure - or how warm their bottom is while driving that BMW with a heated seat - this is their HEALTH! ..
But who are we fooling? Yes - their health/happiness/satisfaction .. that's all the same - no?
Yes - I am trying to provoke discussion. :-) It's nearly 2011. Let's start the blog off to a new year!