事件记录
面试官: Antibiotics, what do they help, what don't they help, and why should you care? 这就是下一期《大发娱乐》.
播音员: 健康信息来自预期，由研究支持. 来自犹他大学健康中心，大发娱乐是scoperadio.com.
面试官: Dr. 萨拉·兰姆是一名内科医生，有着广泛的病人经验, 一个hospitalist, 一个儿科医生. 我相信你们被问到很多关于抗生素的问题. Do you find that there is still confusion with patients when they should be and shouldn't be used?
Dr. 羊: 绝对.
面试官: 好吧. Well, let's clear that up first and then let's talk about why somebody should care about that. 我记得是抗生素，抗菌，这是我的小 . . .
Dr. 羊: 还能杀毒，抗真菌，抗寄生虫.
面试官: 他们也是这样做的 . . . 我以为只是抗生素，只是细菌.
Dr. 羊: 所以抗生素, 我认为, are a broad sort of category for what we would maybe call antimicrobials.
面试官: 好吧. So then what are the rules when they should be used and when they shouldn't be used? 比如感冒，抗生素就不会起作用.
Dr. 羊: 正确的.
面试官: 链球菌性咽喉炎，抗生素会有大发娱乐.
Dr. 羊: 我认为 it depends on, number one, what you think the actual cause of the problem is. 它是细菌，是真菌，还是寄生虫? 然后取决于宿主. 所以你面前的病人, do they have problems that would put them at risk of having an unnecessarily risky course, 如果不治疗，后果会很糟糕? Or are they an otherwise healthy patient with really a very intact immune system who's likely to be able to fight off this infection without any assistance?
面试官: 在过去, I get the feeling that at what point doctors would prescribe or recommend them more often than not?
Dr. 羊: 我认为 we didn't completely understand what may be the cause of many illnesses that patients presented with and what the likelihood was that they would get better on their own without our intervention with an antibiotic. 你们知道, 自, 甚至从我行医开始, 其实只有18年, 大发娱乐从, 你知道, 循证医学, 基于人群的研究, looking at outcomes for patients on a very broad scale to be able to have more meaningful, 关于谁可能会好转的更精确的信息, 谁可能不会好起来, and who is actually most in need of an antibiotic for a particular condition.
面试官: Are we in a bit of a transition where doctors are still prescribing or recommending them when they really shouldn't or they don't need to?
Dr. 羊: 是的.
面试官: So some physicians are on board with kind of what you're talking about, some aren't, why is that?
Dr. 羊: 我认为, 在某种程度上, 医生倾向于做他们觉得最舒服的事情, meaning what they have done in the past historically or what they have seen done. 大发娱乐离得越远, 说, 大发娱乐的培训经历, 住院医师或研究员, 大发娱乐就越依赖自己的设备来获取信息. And one of the most beautiful things about working in an academic center is you're constantly surrounded by medical students, 居民, 总是问“为什么”的人? 为什么不?" And that, in and of itself, forces you to stay current with what evolves in 医学文献.
So the further you sort of get away from y大发娱乐的培训经历 and being forced to be kept up to date with the evidence, 医学文献, 对于什么是最佳实践，你的工作知识可能会滞后. 大发娱乐也看到了很多的进化, 你知道, clinical practice guidelines that have become more the mainstay of practice for things that we have a lot of evidence for, but that still requires physicians to stay up to date with that information on their own.
面试官: So in a lot of ways it brings it back to myself and patients in general that we probably need to educate ourselves a little bit . . .
Dr. 羊: 绝对.
面试官: 关于这类事情. So 我认为 that transitions into what's the downside of just throwing antibiotics at all sorts of problems? One of which, 我认为 a lot of people have heard about is antibiotic resistance.
Dr. 羊: 电阻.
面试官: 是的.
Dr. 羊: 当然，毫无疑问.
面试官: 是的. 简要解释一下这是什么意思.
Dr. 羊: 所以抗生素, 当他们给别人的时候, they will not just take care of the bacteria in your body causing the infection. They will take care of all bacteria that are susceptible to that drug in your body. So that may not affect a few bacteria that would not respond to that antimicrobial. And it sort of disrupts the balance of like the bacteria that are susceptible with the bacteria that are not susceptible.
这样就有可能产生抗药性, 不敏感的生物会失去控制. And so those resistant bacteria then proliferate in the system of the person and then they can, they're more likely to be passed on from person to person or from person to door handle which then gets picked up by the next person walking through that hallway.
面试官: 这种类型的反, 也许这是一个不同的术语, but that type of antibiotic resistance is different than kind of what I was thinking of which is these super bugs that are developing.
Dr. 羊: 好吧，但这就是超级细菌的发展方式.
面试官: 好吧.
Dr. 羊: 是的. So by selecting for bacteria that are in our environment that don't respond to these really big drugs . . .
面试官: 哦，我明白了.
Dr. 羊: 你实际上允许它们繁殖然后扩散.
面试官: 然后引发疾病和问题.
Dr. 羊: 正确的.
面试官: 除此之外, there are some people where the antibiotic can actually mess up your bacteria.
Dr. 羊: 你自己的细菌是健康的细菌.
面试官: 对，尤其是在你的肚子里. C. 我想到了Diff.
Dr. 羊: 绝对.
面试官: 那我怎么能做一个负责任的病人呢? Should I 说 no to all antibiotics if I go in for a surgical procedure and they 说 they want to give me a course of antibiotics as part of that? 我应该说不吗，我宁愿不?
Dr. 羊: No, 我认为 there's a lot of good evidence to suggest that antibiotics have their place and they have a good role in good medical practice in preserving health, 你们知道, 让病人没有并发症. So there's lots of good evidence but there's no reason why you can't push your physician, 你的医生会说, “嗯, 你能给我解释一下吗? Explain why this is going to be beneficial for me and maybe give me some information about what would happen if I didn't go along with this plan."
面试官: 然后也许是态度 . . . is this a good attitude to have, only use them when you absolutely have to?
Dr. 羊: 绝对.
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更新日期：2019年6月6日
最初发布日期：2017年8月15日