Jennifer Davis’ Blog

on prescribing antibiotics:

AFter one week working at Macha I am feeling very humble.  I have so much to learn still.  I am supervised, but I only get input about my medical decisions if I ask for it.  Otherwise, I am seeing my own patients, creating my own treatment plans, and writing my own orders.  This is good motivation for me to really focus on my studies for the rest of this year and during residency.  It’s a scary feeling to be treating patients on your own.  I ahve a new respect for why following standards and paying attention to the literature is so important.  you could spend your life making decisions based on your gut, but how accurate is your gut?  maybe after practicing for decades you’ve seen so many patients that you have this innate epidemiology that develops and you can be pretty safe saying “i just feel like this is the right medication combination to use”.  but after one year of clinicals in med school, i’m sometimes just pulling antibiotic doses and courses out of a hat.  well, my tarascon’s has become my best friend, but we all know that those experienced clinicians usually pick a medication dose that is not the one listed in tarascons, up to date, or the most recent jama article.  thankfully, i have a limited formulary to learn, and there are less issues with antibiotic resistance here, so it is not too complicated to pick the right drug and dose.  But every day on rounds one of the doctors probably looks at my orders and sighs and rolls his eyes and then “tweaks” my plan.  that’s fine; as long as the patients get what they need.  i just need to be hearing about what needs to be changed so that i can learn from my mistakes.  this is part of my education, after all.