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Independents' Day

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

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Readers' comments (6)

  • There’s a popular view that any service that is FATPO is of little value. Easily remedied, even if I might despair at the consequences for some patients.

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  • Bob Hodges

    Only sometimes??

    Can remember our last 'win' myself.......and everytime I looks left and right I see fewer GPs.

    Correlation = causation sometimes.

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  • There IS a simple answer to this - stop taking it all seriously and personally. I consider myself a professional, interested, diligent and careful GP, as are 90%+ of GPs around the country. Why do we seek external validation from the press/NHSE/appraisal etc., etc. - if I go home and consider that I have worked well, done my best by my patients in a crumbling system then I consider i have "done my duty" and have a clear conscience. That the Daily Mail et al will continue to have their hissy fits about how crap we all are isn't my problem - and to be fair, most of our patients still seem to rate us pretty highly. Stop looking for pats on the back from a press geared up for bad news - it won't happen!

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  • I'm glad to see you are turning to Libertarianism, classic liberalism/conservatism, David. As opposed to the Left/socialism/lack of personal responsibility. Welcome! 1 more vote to turn things around, and maybe you could influence even more :)

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  • Ivan Benett

    We will always over do it sometimes and under do it at others. It's the nature of medicine. The sensitivity and specificity of our tools (mostly history and examination) are not 100%. Our thresholds for intervention change according to a whole load of factors including public demand, personal preference, new evidence, peer review and others. There's no point getting wound up about it.
    We should do our best to get it right, recognising that sometimes we wont. That's medicine. That's life.

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  • Is there a degree of resemblance in that photo to a certain Gestapo agent who was occasioanlly seen at Renee's Cafe?

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