Patients less satisfied by GP's who prescribe less antibiotics

[think about it]

An interesting story for general practice this morning.

 

The post on the BBC website today links patient satisfaction with GP antibiotic prescribing levels.

 

http://www.bbc.co.uk/news/health-35008128

As a practice manager I've seen this myself, people wanting to complain that their request for antibiotics (ABx) has been refused, normally accompanied by "well, Dr. X always gave them to me..."

We have a nickname for GP's who prescribe appropriately, Dr. No! Because it seems they spend much of their day saying just that. You find that most younger GP's are quickly labelled as a Dr. No and they quiclky develop a whole tranche of patients who don't want to see them and would sooner see the older, 'easier' GP.

Is it down to GP's who are less strong willed in the past changing public perception and expectations? I think it might be, it's far 'easier' to give someone what they want, but is it clinically appropriate? No, of course not. It was only in August this year that GP's were threatened by NICE with being disciplined for prescribing too many ABx(http://www.bbc.co.uk/news/health-33961241)

So, what's your take on it?

Are you left feeling short changed when you leave the surgery empty handed?

Are you happy that your GP is one of the stronger, more clinically adept ones who prescribe appropriately or would you prefer one that NICE want disciplined/struck off?

[Nystagmite]

There's a notice up in my GP surgery saying that antibiotics won't cure things like colds and you shouldn't make an appointment for things like that. You're advised to seek advice from the chemist.

 

I've needed antibiotics once. Or rather, we didn't have a clue what the problem was at all and was told by the GP it's an infection. That and everything that followed, was not what I was expecting at all.

 

I do remember this year asking for a GP appointment and got asked what the problem was and explained that I thought I'd done something to my kidneys. (I'm on something which can cause kidney problems) As requested, I'd done a urine sample and came back later that day. I was rather embarrassed to be told by the GP "you've just pulled something".

[citizenB]

I would rather have a GP who takes time to listen to my problem, is more up to date and isn't too keen to simply palm me off with a prescription.

 

For years I had one of the GPs who only wanted print off a prescription and it was only about 12 years ago when a younger GP actually delved deeper - stopped issuing pills that were doing more harm than good and set off a train of events that was able to see me receive treatment; that whilst it wont cure the illness, has certainly gone a long way to giving me the opportunity to live my life more comfortably.

 

I have heard stories of patients telling their GP what is wrong with them and demanding treatments/prescriptions and then not being happy when the GP tries to tell them that what they are asking is inappropriate.

[think about it]

I'm similar, I've only ever really needed ABx once or twice for pretty unpleasant sinus infections that have left me with rigors and raging temperatures. I won't take them for many other things, they're often hugely unpleasant in terms of their side effects and I'd sooner save them for if I ever 'really' need them.

 

The phrase I hear a lot about the Dr. No's that I've worked with and known is that people come out saying "I'm not seeing them again, I didn't get anything..." and I tend to bite my tongue when perhaps I shouldn't. The patient may well have come out of the consulting room empty handed but they have benefitted from that GP's experience, training and knowledge and by choosing to not issue ABx the GP is helping that person. Unfortunately, me included here, we all like a quick resolution when we're unwell and for many people it's easy to believe that the answer is in a box of ABx rather than letting nature take its course.

[nolegion]

Couldn't agree more about the need for doctors to be 'resistant' to the superfluous prescribing of antibiotics. Quite apart from the unnececessary NHS expense and the total inefficacy in so many individual cases, I read with alarm about what seems to be genuine and shared scientific concern about the increasing resistance of many type of bug to antibiotics where they would normally be considered appropriate, and effective. It appears that indiscriminate prescribing may be at least partly to blame.

 

This is not just objective altruism on my part. Every few years I tend to develop a condition which if treated speedily is minor, but left untreated can be much more serious. High dose penicillin has sorted it out within a few days in the past. I would like it to stay that way for the next time.

[honeybee13]

I agree about saving antibiotics for when you really need them. The last time I took any was quite a few years back when I had a lung infection that nothing else would shift.

 

HB

[BazzaS]

I'm similar, I've only ever really needed ABx once or twice for pretty unpleasant sinus infections that have left me with rigors and raging temperatures. I won't take them for many other things, they're often hugely unpleasant in terms of their side effects and I'd sooner save them for if I ever 'really' need them.

 

The phrase I hear a lot about the Dr. No's that I've worked with and known is that people come out saying "I'm not seeing them again, I didn't get anything..." and I tend to bite my tongue when perhaps I shouldn't. The patient may well have come out of the consulting room empty handed but they have benefitted from that GP's experience, training and knowledge and by choosing to not issue ABx the GP is helping that person. Unfortunately, me included here, we all like a quick resolution when we're unwell and for many people it's easy to believe that the answer is in a box of ABx rather than letting nature take its course.

 

Sorry it is so technical but :

http://promedmail.org/post/3820586

 

To summarise : an organism that NONE of the antibiotics currently in use that might cover that bug was isolated from a clinical sample.

 

The great and the good (WHO, the Chief Medical Officer for England) talk about the risk of antibiotic over prescribing and a "post antibiotic era" where the antibiotics we have don't work due to resistance

 

To those patients who you have to bite your tongue : it'd take time but can someone explain it to them?

Even better if there are patients in their 80's and 90's who can remember people dying of scarlet fever and houses with sheets doused in Lysol up in the doorways to stop the bug spreading

(As a child my sister got scarlet fever. That is what my Gran wanted to do. The GP said "we don't do that anymore - she just gets 10 days penicillin)

 

It depends if people want to go back to that pre-Antibiotic era.

They need to understand the risks.

 

It isn't "you won't get antibiotics" : it should be "you get antibiotics when you need them : the right one at the right dose for the right length of time, then stop"

[citizenB]

Back in 1955, the GP we had at the time started to prescribe penicillin for absolutely everything Mum took us to the doctor for.. overprescribing meant that I am now allergic to this one.

[Sali]

Curbing the over-use of anti-biotics is everyone's responsibility.

 

Otherwise healthy individuals should not expect them to be dished out for minor ailments or where the cause is obviously viral.

 

Doctors should not be so quick to indulge patients. They are meant to be the knowledgeable professional. After all, it is possible that at some point in the future their own lives and the lives of their loved-ones could be at risk. Use what's left of the ten minute appointment explaining the consequences of overuse of these medicines. Hopefully, the message will get through to some.

 

Obviously what we need is a quick way (I mean in hours) of identifying whether an anti-biotic, (and which one), will be effective as a treatment.

 

This is a world-wide issue. Anti-biotics are available like smarties in places like India, so acting alone will not protect us.

 

Lastly, the world needs to be willing to fund research into new anti-biotics, otherwise we will be back to Darwin's survival of the fittest...or perhaps it was always thus.

[citizenB]

http://www.bbc.co.uk/news/health-35030262

 

Farmers need to dramatically cut the amount of antibiotics used in agriculture, because of the threat to human health, a report says.

 

Some infections are becoming almost impossible to treat, because of the excessive use of antibiotics.

 

And more than half of those used around the world are used in animals, often to make them grow more quickly.

 

 

 

Saw this on the news earlier on. Apparently the amount of antibiotics in Animal feed is also a cause for concern

 

 

In the US alone, every year, 3,400 tonnes of antibiotics are used on patients, while 8,900 tonnes are used on animals.

 

The economist who led the review, Jim O'Neill, said such figures were simply "staggering" and 10 million people would die each year from drug-resistant infections by 2050.

 

[Nystagmite]

I found at my old GP surgery there seemed to be GPs who were rather quick to hand out medication instead of trying to find out what was wrong. There was one GP who would try to find out was actually wrong.

 

Anyway, I was having some quite serious neck problems and had been given Naproxen which did nothing and had been asked to return 2 weeks later. I saw a GP (the one mentioned above) who said "I have no idea what's wrong with you. So, I'm going to refer you to someone who knows more than me". He is a really good GP.

 

There are certain GPs I have refused to see. But one has sat there and told me I'm faking all the problems I'm having because the scan says so and do I want talking therapy. You can't see pain. I've had some who have ignored my symptoms completely. I remember my mum telling the neurologist that she'd constantly take me to the doctors as a child because I'd vomit at night, only to be told there's nothing wrong and she's imagining the whole thing. We discovered some years later, she was right all along.

 

No problems so far at current surgery. Have a few times gone in there hoping for something to happen (ie, I can't use eye drops and need gel) and haven't had any problems at all. Although, last time, I didn't just walk in and say "I want a referral please".