There is a concept called "samatha" in Buddhist meditation. It has to do with sitting quietly, doing nothing. The opposite of mindless action, samatha is the cornerstone of the mindfulness practice. But what does it have to do with antibiotic resistance?
Well, I came across this interesting slide presentation by Dick Zoutman from Canada. Starting at the top of page 5, the talk goes into several fascinating surveys about what influences antibiotic prescribing for upper respiratory tract infections (URTIs). The first survey was of 316 family MDs in Ontario, which, among other factors, determined "physician's desire to act" as a risk factor for prescribing an antibiotic. The next survey of 313 patients identified patient expectation to receive antibiotic as the most important driver of prescribing behavior. The latter can be interpreted as a). the patient's preference for some kind of an action or b). the patient's expectation of action on the part of the MD. Either way, "action" is the operative word.
So, what does this mean? Well, at the simplest, most immediate level, this finding confirms that education of both physicians and patients is a potentially fruitful target for antibiotic stewardship programs. But at a deeper level, perhaps something as fundamental as a re-evaluation of our approach to life is what is needed. Antibiotic overprescribing is a clear example where the philosophy that doing something is better than doing nothing is not just wrong, but threatens to send us back to the dark age of pre-antibiotic era.
Western medicine in general promotes rapid decision-making as its paradigm. In fact, when I was in practice, there used to be tremendous political capital in the bravado of rapid assessment and planning. But let's not kid ourselves: the majority of treatment decisions made in the outpatient setting do not necessarily need to be rushed in the way that our expectations have driven them to be rushed. So, let's take this sage advice and "don't just do something, sit there". It is time for some samatha in our decision-making as both physicians and patients, lest we continue knee-jerking our way into this escalating resistance catastrophe.
Thank you for starting this discussion Marya. So important. I recently discovered that I have intestinal parasites and my doctor prescribed antibiotics and some other strong anti-parasite medicine. I first went on google and searched the parasite and treatments and found out that I didnt really need such strong medicines for this.
ReplyDeleteMy next goal was to find an integrative health doctor who would know how to deal with parasites while keeping my whole body in perspective. I found some who gave me an appointment for March, but I needed to know now if I need to do something because I was feeling fatigued and needed to take the "right" action right away. While searching for a holistic doctor I went to my friend Verena Smith who gave me Dr. Clarkia to treat the parasites, which my body felt good taking.
But my search was on and soon enough my friend Deb Waldron referred me to Dr. Hesse with whom I got an immediate appointment. After spending 2 hours with me he gave me some natural remedies to compliment Dr. Clarkia in treating my body. I am feeling so much better already, within 1 week of his medications and his approach which is taking into account mind, body, and spirit.
I like your mindful approach to medicine. I did not rush in but listened to my body, took what I needed and discarded what I did not and found the right people to support me in my journey defined by mindful living.
Good post, Marya - thank you -
ReplyDeleteSean
Makes interesting reading, but perhaps infective processes are a poor vector for promoting meditative prescribing practices. While, without a shadow of a doubt, it is vital to ensure doctors are prescribing properly and diligently (resistance is a serious problem which in theory is easily tackled at prescribing level), most infections cannot be allowed to go unchecked.
ReplyDeleteThe principle of watch and wait rarely applies to infective processes, particularly bacterial ones. In the healthy, many infections will be eradicated, albeit over a longer period, granted. There's a caveat though. Even if we don't take into account the time lost in waiting for self-healing, long lasting damage can be done if infections are allowed to run their natural course.
A very apt principle for chronic disease in general, and I agree with you, but we can't throw caution to the wind and blanket all of medicine.
Keep up the excellent blogposts!