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Gold, incentives and meh

Alun George

  • Pregabalin and gabapentin set to become controlled drugs

    Alun George's comment 24 Sep 2017 5:58pm

    Useful for a small group of people, but addictive and abusable. In the acute setting and some cases of true neuropathic pain, have some benefits.

    Like opioids, the problem is they induce euphoria - and persistent pain is a complex phenomenon with low mood being one of the components. So we prescribe a drug which isnt helping the pain, but it temporarily makes patients feel better for a few hours - so of course they will like it. But is it much better than asking them to drinking a few pints to take their minds off things? No - very short term, great - but long term, harm and dependence have potential to rear their heads.
    Persistent pain doesnt respond well to pharmacology - it needs a psychosocial approach (Pain toolkit is good as a starting point) - this takes time, we dont have much of it, nor resources. So can see why prescribing a short acting euphoriant can be seen initially as success.....until they come back for more wanting higher doses........Same principle as applies to opioid prescribing concerns - and benzos etc....

  • Saying 'no' to antibiotics is easy

    Alun George's comment 24 Aug 2014 9:16pm

    In response to the medicolegal argument for prescribing - it's about note keeping. If you make clear notes that antibiotics are likely to offer nothing I'd love to hear any case that won this by going to their solicitor. The Centor criteria, the Traffic light system - as long as it's documented. If anyone has documented this and been found lacking I'd love to hear about their experiences

  • Half of doctors have faced bullying at work

    Alun George's comment 08 Jul 2014 11:18pm

    Depends what they're being bullied about - if its abusable drugs then they need training on saying now and lots of support from fellow colleagues and senior staff and very clear policies on when they can say no to prescribing (e.g. pregabalin, benzos etc in a patient with substance misuse issues)
    Also a clear no tolerance policy

    Alas with general practice become more and more busy what this suggests is we no longer have the time to support each other

  • GPs face tighter prescribing rules on tramadol and temazepam

    Alun George's comment 04 Jun 2014 8:26pm

    Great - next pregabalin and gabapentin. None of these things should be on repeat except in exceptional cases