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