Turbohot

Ellie, a lot of people have plenty of regard for the pharmacists. There have been numerous occasions this end when doctors have given medications that were questioned by pharmacists and even corrected (they sent the patient back for another consultation with the doc or rang up the surgery) in terms of combination, dosage and even the prescription itself for the health issue. There's a growing respect for pharmacists from public due to their expertise and their attention to detail.

mattvortex

When you say flu-i think you must mean man-flu because if you had real infulenza you certainly wouldnt have been able to go running!!
A good way to tell if you have flu is to imagine there a £50 note on you doorstep;
.ifs its just a cold you would go and get it.
. ifs its influenza you wouldnt even think about getting out of bed to retreive it!

Incidently, heavy exercise with even just a simple cold can be very dangerous- a teacher at the school nearby nearly died when he thought it would be a good idea to go for a run whilst suffering from a heavy cold.
He ended up in intensive care because the cold virus infected his heart and he was very lucky to recover.
The doctors basically told him that its bacause his immune system was under pressure and weakend trying to fight the cold virus, and the heavy exercise enabled the virus to infect the heart- told not to do something as stupid again!

john banks

Just before Xmas a patient told me in all seriousness that I may as well write their death certificate if I wouldn't prescribe antibiotics. Another was so vociferous in their request for antibiotics that it got to the point that I suggested that our relationship had broken down and they find another doctor. I don't get it right all the time and that isn't the issue but when longstanding patients who I have been through a lot with and despite 20 minute repeated, calm, polite but firm and reasoned explanation doesn't get through then I think my claim that patients are putting inappropriate pressure to over prescribe antibiotics is justifiable. One patient later apologised, and the other's daughter apologised on their behalf, neither came to harm, both had VERY good reasons not to prescribe but every communication technique failed.

Turbohot

Both patients sound very impatient and unreasonable, John. There should be some placebo meds in replica packaging to shut such patients up. I can imagine the difficulties a doctor can face. A competent and confident doctor will stick to his grounds like you did, and be prepared to treat the disease with antibiotics if required. You seem to be that sort- good on you. No one gets things right all the time. Doctors are only humans. Patients need to remember that.

Not all patients put this sort of inappropriate pressure (or any pressure) on their doctors and it's the doctors who prescribe antibiotics such as Amoxicillin for their Tonsillitis/sore throat. Both things i.e. irrational patient experiences and misdiagnosis/over-medicalising by over-confident practitioners are wrong.

I'm not sure whether most of the times antibiotics are over-prescribed due the inappropriate pressure caused by the patients, fear of litigation from them etc. If the doctor didn't prscribe any antibiotics and if the patient got better without them, what is there for the patient to sue the doctor with? Nothing. Obscurity of the symptoms at the onset or during the maturation of the infection may play a part in prescribing antibiotics; just in case the infection progresses to be worthy of antibiotics later, anyway. Like you say, strep throat can be misread by some doctors, so can other infections be. However, that shouldn’t be the case unless it has been established that the infection is serious enough to be treated with antibiotics, I understand.

Matteeboy

I am a case in point for the exercising while still ill error. A year of utterly wrecking my immune system; had blood tests, all sorts but couldn't suss out what it was. Now I rest properly two days a week and no longer consider being ill to be rest! As soon as I got better, I used to go for a hard run/cycle.

A year of every illness going. Not fun. Now back on track again.

john banks

Before the following I will preface it with the obvious that I'm delighted to suggest and prescribe an antibiotic when it is clinically indicated/useful. However, most of the time when a patient asks for an antibiotic it is inappropriate based on clinical research and guidelines so if patients ask I'm already on the defensive and know there will be a discussion to reset their expectations whilst not appearing to be uncaring, stingy or incompetent. I would say that 90% of the time that conversation is a success and patient surveys of consultations back that up, with many thanking me for the information. The difficulty is the remaining approx 10% that are tricky to reason with, and a few percent that are downright obnoxious about the whole thing as in the two recent examples I gave.

It is OK knowing that a recent study of 2000 patients with placebo vs amoxicillin for what appeared to the doctor to be an uncomplicated cough (there are similar ones for sore throat without exudate/pus) only resulted in three admissions to hospital, two in the amoxicillin group and one in the placebo group and that the number of patients needing to be treated with amoxicillin for one to benefit was 30, but the number needing to be treated amoxicillinfor one to be harmed was 21. You can give as much of this information to your patient as they wish at a level appropriate to the interest, education and understanding. However, if you don't have the confidence of your patient, an agreement that they realise you are trying to do the best for them in good faith and with good ability, and that they will contact you in the event of complications without pointing the finger of blame at you retrospectively then it is a pleasant outcome for all concerned. There is always some uncertainty involved regarding future events and the present culture is increasingly threatening and one of blame. Until more doctors get sued for the complications of inappropriately using antibiotics, they will give in to patient demand because antibiotics are considered the safer option (even though they are not), and more doctors get criticised by the public for not prescribing when it was not forseeable that they would help compared with prescribing when it was going to get better anyway.

It is such a serious issue for public health that this week we start an initiative to measure our use of 4C antibiotics which give the highest C diff risk (ciprofloxacin, cefalosporins, co-amoxiclav, clindamycin) and compare it to the same quarter last year. It is quite handy to be able to blame the decision not to prescribe on someone else (even though I agree with that third party), and can be the only thing left when some patients won't listen to reasoned argument. I sometimes have to resort to that tactic with benzos and opiates too.

It is fun dealing with the public most of the time, but it is complicated when the stakes are high and you do not have agreement with your patient and they think they know better despite good evidence to the contrary (not just because "I'm the doctor and I know best"). If you have done everything you should and don't given an antibiotic for sinusitis and due to sheer bad luck that patient gets a brain abscess, even though research shows no evidence of excess risk, it can be one hell of a complaint to deal with and your care could be gone over with a fine tooth comb. Sometimes the committees looking at these matters just find something to criticise you on using the benefit of hindsight. The unrealism of some of the recommendations is a farce - for example, "all headaches should be sent to hospital for assessment" (and indeed one local GP did just that every shift he was on so that I knew his voice on the phone amongst 150 local GPs and most of his admissions were headaches, never of any consequence in 6 months I did that job, but there was obviously a story behind it).

RobsyUK

iTrader: (2)

Well, the sore throat finally went but then I was stuck in bed with cold sweats, dizzy head even throwing up - hadn't eaten anything for 3 days so it was just bio but gave me sever cramps. Yesterday I tried lemonade and luckily wasn't sick so I'm trying to drink more water and even sneaked a biscuit

Hardly had any sleep and waking up throughout the night soaked with sweat but freezing.
Might tackle a shower in a sec and wash the bedding. It's amazing how much snot is up my nose and on my chest. Havent even had a cigaret nor fancy one...