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Tuesday, September 9, 2014

Uncovering Why Some Doctors Don’t Understand Sepsis

Steven Q. Simpson, MD
Guest Author: Steven Q. Simpson, MD
University of Kansas and Sepsis Alliance
I am one of the newest members of the board of directors of Sepsis Alliance.  If you haven’t heard of Sepsis Alliance, it is a non-profit organization whose aim is to heighten awareness of severe sepsis as an emergency among the general public and among healthcare providers (www.sepsisalliance.org).  I joined this movement, because the need is strident.  Severe sepsis is the secret killer.  Even though its historical mortality rate is as high as 50%, it is under recognized as a cause of death.  For example, we know that cancer is a leading cause of death in the US, and we spend billions of dollars on cancer research to find preventions and cures.  Yet, what is the single largest cause of death among cancer patients?  It is listed as infection, at 48% of cancer deaths, but it is not the infection, per se, that kills.  It is the severe sepsis engendered by the infection.  And most of those deaths are logged as cancer deaths.
A large part of my own career has centered on teaching physicians, both young and old, how to recognize when they are looking at severe sepsis and how to respond quickly and aggressively.  We have substantial data from numerous trials, observational studies, and quality improvement studies that interventions can be relatively simple, consisting of antibiotics and fluids.  But only when the condition is recognized early and the treatments are given rapidly.   When there are delays, severe sepsis can rapidly become septic shock, with substantially higher risk of death.  You might think that this would be an easy sell for physicians who, after all, are there to save lives.  But you would be wrong in many cases.
After literally hundreds of lectures and workshops across the nation, I think I have worked out the root of the problem.  Nearly all doctors feel as if they know what sepsis is, having heard the word from the very beginning of their medical school careers.  Yet, many doctors have actually not been exposed to the standard definitions that critical care physicians have been using for about two decades, since they were published in 1992: infection, with SIRS and organ dysfunction.  If one stops to think about it – and I have stopped to think about it many times – the majority of physicians aged about 45 to 55, those in the primes of their careers, were not exposed to the definitions during their training.  Most often, when these docs think of sepsis they think of what we who deal with it would call septic shock, often with multiple organ dysfunction.  Often, these providers tell me that they don’t really see all that much sepsis in their practice and that when they do see it they ship it immediately to a larger center.  As a result, my job of informing and updating physicians is not going to go away anytime soon.

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