The 15 days that made no difference
Computers have had an extraordinary effect on general
practice. Where once I wrote all my notes in longhand on those ridiculously-sized Lloyd George record cards, now every consultation is entered into the computer, dramatically increasing legibility, searchability, and code-ability.
We've somehow lost an intangible something that flowed from the doctor's handwriting, but I wouldn't go back, despite the intrusive effect of the computer on the consultation. If nothing else, it is impossible to imagine how we would ever be paid, and the thought of manual entry of data into QOF templates is horrifying.
Computers have certainly made it easier to count what we do. I'm sure that if I had been computerised earlier in my career I would be able to tell you in this ophthalmology issue how many cases of conjunctivitis I've seen in my working life, but as it is I'll have to guess. If I saw one case every two weeks – and that is probably an underestimate – this will have equated to about 750 pairs of sticky red eyes. That's a sizeable slice of my work over the years.
This has huge therapeutic implications. Until very recently I inevitably issued a vast number of prescriptions, typically for chloramphenicol eye drops or eye ointment.
I have not been alone. Each year there are about a million consultations about children with conjunctivitis – it is perhaps the commonest ophthalmic condition.
This fact makes it all rather dispiriting that research has now shown that antibiotic eye drops are rarely essential, certainly in children, and are probably about as effective as a placebo. Just think of the hours wasted: 750 consultations would total some 15 working days if I managed to spin the consultation out to its allocated ten minutes.
That's an extraordinary waste of time. And ponder on the fact that at the same time that research has shown that treatment is unnecessary, this same treatment has been made available OTC without a prescription. You are right to be puzzled, and I am sure you will both hope and expect that pharmacists will advise parents not to buy the treatment. We shall see.
It certainly sets me pondering as to exactly how much of my career has been spent prescribing other apparently useless treatments for self-limiting conditions and then taking the credit for recovery. It's not just conjunctivitis: since I became a GP antibiotics have fallen out of fashion for lower respiratory infections, otitis media and tonsillitis.
But that's the virtue of research. Using the accuracy of the retrospectoscope, it is now clear that most of the therapies I prescribed in my first weeks in practice were inappropriate, unnecessary, or of dubious value.
Those with long memories will remember prescribing Actifed Compound linctus and oxytetracycline for chest infections.
But all we can do is do the best that we can at the time. And hundreds of parents have been grateful that I gave their child antibiotic eye drops for their conjunctivitis – after all, the proof of the pudding was recovery.
And for all the criticism that mainstream medicine faces, it does subject itself to trials that may prove that it sometimes lacks value. This is more than can be said for some complementary therapies – at least we admit it when we've got things wrong, even when it is 750 times.