Page 5 - Mecklenburg_Medicine_January-2017

I Resolve President’s Letter

By Stephen J. Ezzo, MD “recommended” ones, prioritizing those needed for school. I
will strive to change that, with three in particular.
H appy New Year 2017! I would like to take this
opportunity to wish everyone a happy and safe Hepatitis A. The world has shrunk. Last year I went from
2017, and I hope your holiday season was spent New York City to the very bottom of South America in less
with family and loved ones. than 24 hours. My patients go on mission trips around the
Are you hard at work on your resolutions? I have my usual world, and several of them spend significant time overseas
during their college years. I cannot be assured of their food and
dozen or so all in line — lose weight (again), exercise more water sources anymore.

(again), take more time for myself, visit my parents and family Influenza. Despite the ever-changing efficacy of the vaccine,
and the difficulty in recording actual flu deaths, studies have
more often (good bet on that one), and listen to my wife when estimated that annual flu vaccine can decrease flu-related
pediatric admissions by 74 percent and adult flu admissions by
she is talking to me (probably even-money). 57 percent. Furthermore, I am convinced Tamiflu is not a good
alternative, and I worry about increasing resistance to the drug.
I believe we view our resolutions with varying importance (On a side note, I have spun the poor performance of Flumist as
further proof that vaccines are closely scrutinized, not only prior
depending on how realistic we are about them. But whether to release, but afterwards, as well.)

I challenge you to we keep them for a Gardasil. I continue to be flummoxed by parent and patient
pick out one or two month or an entire resistance. This is a vaccine to help prevent cancer. Read that
issues to redouble year, they at least again (and not because of its singular brevity). And not just
your efforts in an provide us with the one type of cancer. I know one big issue is the fact that HPV is
sexually transmitted, and some parents think their kids won’t
chance to review engage in that type of activity. This is a sidebar discussion that
where we stand in needs addressing. A recent study showed a 56-percent decrease
our lives and what in vaccine-type HPV infections in girls ages 14-19. This, despite
only one-third of girls in this age group receiving the full vaccine
attempt to improve, we would like to series. What if this was a pill instead of a vaccine? We tout all
not just your see changed. our other cancer treatments, why aren’t we shouting this from the
patients’ health rooftops? (I am quite pleased with the new TV commercials on
individually, but Along those lines, this, and I tend to be dismayed by most medical ads.) Again — a
the health of what do we resolve cancer vaccine.
in our professional
lives? This is a good Antibiotic Use. This is a Brobdingnagian problem that
time to look at how threatens each and every one of us as to how we practice
we practice our craft medicine. A few quick statistics:
• 260 million antibiotic prescriptions are written in the outpatient
the community and how we can
you serve. improve the care of setting each year across the country.
our patients. There • It is estimated half of those are unnecessary (usually for viral

are general themes respiratory illnesses).
• About 60 percent of all antibiotic prescriptions are for broad-
that can apply to all:
spectrum antibiotics.
spending more time • There are 435,000 cases of C. Difficile yearly in the United

in direct contact with the patient rather than the EHR (or in States, with more than 29,000 deaths.
We are familiar with the reasons for overprescribing
my case, not smashing the infernal machine with a ballpeen antibiotics, and we can quote them chapter and verse (not enough
time to explain why they are not indicated, patient satisfaction,
hammer), asking more open-ended questions, interrupting less, worry about missing something serious, inconveniencing patients
by having to call or come back, fear of patients leaving us for
and creating a more concise and clear encounter note. another provider).
I also think we feel at times that we are only one person and our
I challenge you to pick out one or two issues to redouble your

efforts in an attempt to improve, not just your patients’ health

individually, but the health of the community you serve. Let me

share my top two for the coming year.

Vaccines. I think we all can agree that vaccine development

was one of the great medical achievements in the 20th century,

and shows no signs of abatement. To highlight just a few of

the remarkable accomplishments — smallpox is gone, there

have been two reported cases of diphtheria in the U.S. in the

last decade, and the Western Hemisphere has been declared

free of endemic polio, measles and rubella. I have tried to be

vigilant on the “required” vaccines during my career and will

continue to do so. At times, I have pushed not as hard on the

Mecklenburg Medicine • January 2017 | 5