Delayed Antibiotics

Living Well in Myanmar

Convince your doctor not to give you medicine

On the weekend of December 5-7 the General Practitioners Society of the Myanmar Medical Association held its annual Scientific Conference.  The GP Society has been bold in providing continuing medical education for Myanmar’s primary care doctors during the last decades of minimal government investment in health training.  The Scientific Conference is an opportunity for doctors to get together, improve clinical skills, try to avoid to much influence from pharmaceutical sponsors, remember med school stories, and cover classics in evening karaoke sessions. 

This year’s theme is “Family Practice: A necessity for medicine in Myanmar”.  During the conference members of the GP Society will discuss the establishment of a College of Family Physicians Myanmar.  The intent is to improve the training of primary care doctors, and one of the weekend’s presentations helps explain why this matters.

The global medical community struggles with the unnecessary prescription of antibiotics.  Not only does it potentially harm a patient to give medicine that isn’t needed, the big fear is that antibiotic resistant bacteria will be created when medicines are inappropriately used.  From a public health and safety perspective, it can be argued that one of the greatest advances in medicine in the last decades has been learning when to not prescribe antibiotics. 

Western countries are to be respected in their efforts to stop the dispensing of bacterial antibiotics to patients who most likely have a viral infection, and therefore won’t benefit from the pills.  However, from a global health standpoint, the low hanging fruit for physician behavior change that combats antibiotic resistance is in a country like Myanmar.  Almost all physicians in Yangon are aware that we doctors prescribe antibiotics excessively.  Even more ominous is the widespread selling of antibiotics from the thousands of places in Myanmar that offer pharmaceuticals in their shopfronts.

This health system-wide challenge is perhaps best addressed by starting with improved doctor training.  At the coming Scientific Conference, Dr. Wut Hmone Hlaing, a junior physician participating in the Journal Club of the GP Society, will present research published earlier this year in the British Medical Journal suggesting that delaying the prescribing of antibiotics results in less pill usage without negatively affecting patients’ time to recovery.  In the study the doctors asked the patients to wait a 2-4 days before taking antibiotics for their respiratory tract infections.  After a few days most patients started to feel better and therefore never took the medication.

Any Myanmar GP in attendance during this presentation stands a chance of reducing their unnecessary prescribing of antibiotics, thereby assisting the global fight against antibiotic resistance and improving patient care.  However the leap from what a doctor learns in lecture to what they actually do in clinic is substantial.

In taking care of people simultaneously in Myanmar and U.S.A, I’ve found that my Californian patients are often relieved that they don’t need antibiotics, while my patients in Myanmar are confused why I’m denying them medicines.

Having the skills and confidence to educate patients is one reason why a better way of training primary care doctors in Myanmar is important.  The GP Society’s establishment of a college that trains Family Physicians will create doctors who make better clinical decisions, improve patient health, and improve the likelihood that the Myanmar health system can achieve goals with limited financial resources.  © Christoph Gelsdorf 2013