Sometimes we really can’t win
Dr David Turner
There are more than 250,000 cases of sepsis per year, and over 50,000 deaths.
Recent reports suggest that a quarter of patients suffering from sepsis experience a delay in getting antibiotic treatment.
‘A fifth of prescription antibiotics given out by GPs are to patients who do not need them’, reported the Mail Online in 2018.
In the early stages, patients who go on to develop sepsis will present in the same way as patients who do not go on to develop sepsis. Every patient with a cough, cold, sore throat or cut finger has the potential to develop sepsis. Sure, there are high-risk patients - those who have diabetes or are immunosuppressed, for example - but for many who develop sepsis following a minor infection, it’s just bad luck.
So what do we, as GPs, do? On one hand, we are being lambasted for overprescribing antibiotics and fuelling antibiotic resistance, and on the other we can be criticised for not prescribing in a patient who goes on to develop sepsis.
On one hand, we are lambasted for fuelling antimicrobial resistance, and on the other we can be criticised for not prescribing antibiotics to a patient who goes on to develop sepsis
This type of dilemma is not confined to antibiotics, and has been a common theme throughout my career.
Twenty years ago, we were told to start all post-menopausal women on HRT, but a few years later we were told that HRT was the Devil’s potion, as it was going to give them all heart disease and cancer.
When SSRI antidepressants were just coming into vogue, we were told we were too shy in prescribing them, and leaving depressed patients untreated. A few years later, yes you guessed it, we are accused of handing them out like Smarties.
We over-diagnose asthma; don’t pick up enough cases of COPD; refer too many people to secondary care; don’t refer patients who may have cancer quickly enough. There aren’t enough GPs; all GPs are lazy and greedy; and spending half their day on the golf course.
The (mostly popular) media loves to paint us in one extreme or the other, and seemingly, with the ability for doublethink that would make Orwell rotate in his grave, forget their opposing view of primary care physicians that was being espoused a few weeks before.
There is no simple answer to this, but a way forward would be to improve personal responsibility. From the day children first arrive at school, let’s encourage independence and embed in them the skills of intelligent scepticism, critical analysis and, above all, the understanding that the overriding concern of most social media and popular press is not to give them a reasoned view, but to make money for their shareholders and billionaire owners.
Dr David Turner is a GP in North West London