In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.Background & Regional DifferencesDr. Dvorin’s clinical journey from New England to New Orleans. Noticing increased use of corticosteroids for common conditions in the Southeast. Discussion of how steroid prescribing practices vary by region and setting.Inappropriate Steroid UseCommon conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, r...
In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.
Background & Regional Differences
- Dr. Dvorin’s clinical journey from New England to New Orleans.
- Noticing increased use of corticosteroids for common conditions in the Southeast.
- Discussion of how steroid prescribing practices vary by region and setting.
Inappropriate Steroid Use
- Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.).
- Trends showing increased steroid prescribing over time.
- Similar patterns observed in emergency, urgent care, and primary care settings.
Risks and Side Effects of Short-Term Steroid Use
- Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia.
- Dose-response relationship: higher doses and repeated use increase risks.
- Some side effects (e.g., bone loss) may persist beyond two months.
Patient Communication & Shared Decision-Making
- Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age).
- Strategies for educating patients and managing expectations.
- The role of patient education videos and resources.
Impact of Provider Education & Quality Metrics
- Ochsner Health’s initiatives to reduce inappropriate steroid use.
- Use of CME, quality dashboards, and feedback to clinicians.
- Evidence that education and reporting can reduce unnecessary prescriptions.
Special Populations & Scenarios
- Considerations for pediatric patients and repeated dosing.
- Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases).
- The need for evidence-based practice and inter-provider communication.
Medical-Legal Considerations
- Lawsuits related to steroid side effects (e.g., fat atrophy, infection).
- Importance of documentation and informed consent.
Alternatives & Symptom Management
- Focusing on treating the patient’s most bothersome symptoms.
- Non-steroid options and the value of patient education about illness duration and expectations.
Resources
- Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube).
- Reminder of EB Medicine’s journals and resources for further learning.
Conclusion
- Key takeaway: “Do no harm” and practice evidence-based medicine.
- Encouragement for clinicians to review their prescribing habits and educate patients.
Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck
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