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We need support in delivering the antibiotics message

Dr Zoe Norris

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We can finally see the light at the end of the tunnel of the cough and cold season. It’s been especially nasty this year, and the fact I have at least two patients who ended up being admitted with proper influenza scared me.

Like many of you, I’m sure, I also suffered with the neverending cough, so I’ve been able to sympathise, empathise and catastrophise when patients share their tales of woe.

This doesn’t meant I don’t see a problem in patients consulting with a cough. (My own mum doesn’t believe my protests that I don’t need to see a GP for my cough – despite my being 37 and, you know, a GP myself.)

Every year we try signposting, patient education, delayed scripts, no scripts. We all have our patter for the nasty URTI, and the cough (you know the one: ‘Good news, you don’t need antibiotics and the potential side-effects they bring *cheery smile*! Bad news, there’s not much I can do to make you feel better *sad face*. But here’s a nice leaflet *cheery face again*).

Yet our heroic efforts to put patients off antibiotics are not getting the credit or support they need. Dame Sally Davies, the chief medical officer, has been telling the press that a third of antibiotic prescribing in primary care has no reason attached to it. In other words, when they look at the notes of patients given antibiotics, we’ve either put nothing to explain why we issued them, or something suggesting they weren’t needed. You know the one: ‘Four-day history of dry cough and sore throat. Throat slightly red, chest clear. Amoxicillin 500mg tds issued’.

I accept that sometimes we get this wrong, but we do need a little help every now and again. We can hardly be blamed for the sins of our secondary care colleagues, such as when urology gives every patient C. diff, or when A&E discharge letters bear no resemblance to local guidelines, or when the respiratory clinic asks us to put a patient on a long-term course for its anti-inflammatory effect.

Our heroic efforts to put patients off antibiotics are not getting any credit 

But, above all, the message needs to get through to the public. The campaigning – including those dancing pills – has improved, but no one thinks it applies to them. Why?

Because they feel really ill, because it’s gone on longer than a week, because their sister’s cousin’s friend has the same thing and got antibiotics. The message isn’t getting across in a way patients understand. Handy prescribing guidance, information prescriptions, poster campaigns – all are useless if they don’t make patients stop and realise it means them.

I’m sure if PHE took a few tips from advertising execs we’d be a lot better off. Tesco can persuade me which toilet roll to buy, that I definitely need a sharing pack of chocolate (not to share of course), and that lavender-scented ironing water is essential. Can’t we employ some of these tactics on patients?

So, Dame Sally, instead of pointing out GPs’ foibles – which are not exactly helped by an unmanageable workload – consider how to deliver the message that an individual’s own actions can affect the system as a whole.

Because the current approach just isn’t working. If we’re left flogging ourselves at the coalface with no support, you’re lucky we’re not still using leeches for everything.

Dr Zoe Norris is a GP in Hull. Read more from Norris at pulsetoday.co.uk/norris

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Readers' comments (8)

  • We need to indoctrinate children from the age of 4 with the message: 'Antibiotics do not help viruses'
    This needs to repeated every day in classrooms around the country like a communist mantra.

    Secondly we need a few characters on soap operas dying from antibiotic induced anaphylaxis after taking an antibiotic they didn't need.
    These measures might influence Joe Public, the RCGP and Sally Davis are never going to.

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  • We could give placebos......or pretend our sats probe is capable of establishing their "systemic bacterial load"- oohh look you score 99 thats 99% chance it's viral......or ask them to get in to a pretend MRI machine made from Blue Peter instructions that then prints an immediate report saying they have no bacterial infection (really a proforma that comes out of the printer)

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  • David Banner

    stop prosecuting GPs for “missing” sepsis.

    That patient with a nasty cough you saw on Monday who died from sepsis Thursday. Did you prescribe amoxicillin ?
    If “yes”, you did all you could, doctor.
    If “no”, it’s GMC and possible gaol time.

    The irony is that overprescribing has rendered common antibiotics useless against many bacteria, but they are a vital fig leaf defence against a vengeful, adversarial and blame/shame legal system.

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  • David, of course you're right. It runs deeper though. You can educate as much as you like, but as long as Joe Public views GP consults and antibiotics as 'free treatment', they would continue to believe they are the special cases that seem to happen all the time. Even that is scratching the surface - what do you think contributes to the wildfire blame/shame legal system? Legal aid.

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  • The NHS is free at the point of delivery which means they turn up for any old rubbish.Make them pay and see how quickly they become responsible.

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  • If you correctly avoid prescribing antibiotics in 99 patients the benefits you will bring to society are not easily tangible and way in the future. F*^% up by not prescribing once and the trail of blame easily leads to you and you will get done.

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  • The message from hospital staff is that patients must get antibiotics from their GPs for every viral cough and cold.
    The message from mass media is that you will have to fight hard top extract antibiotics from your GP, but you are entitled to them.
    Second message from BOTH is that 'sepsis' is rampant and inevitable consequence of lack of easily available 'effective' (ie STRONG ENOUGH) antibiotics.
    And farmers want to give more antibiotics to animals to be competetive with american producers, so what chance have we got???

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  • Can't help but thinking that Dame Sally would be just a little bit useless if she were on the front line.
    Evidence based on her being just a tiny bit rubbish in her ivory tower.
    In other news anyone tackling the antibiotics in agriculture issue yet? Or how much better we are at antibiotic prescribing in this country than many others?? Of course not. British press just wants to wallow in negativity and its own shit, and Dame Sally just loves to feed it.

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