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At the heart of general practice since 1960

Don’t take us back to the 18th century

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Many years ago I went to visit my grandmother, and let myself into the house to find her bouncing off the walls, having a conversation with her long-dead father, singing a selection of hits from My Fair Lady in a Cockney accent (surprising, given that she was from Leeds) and depositing small quantities of pee in every corner of every room.

Luckily I had some cephalexin in the back of the car, and 12 hours after forcing a tablet down her throat (in between lines from ‘Wouldn’t It Be Loverly?’) she had sobered up, showered herself and was watching the cricket with me. Later she was in such fine fettle that we drove to Morrisons to buy frozen prawns, cakes and stout as usual.

This is a modern miracle. There are two wonderful advances in modern medicine; antibiotics and vaccines. Without them, we GPs would not be all that far from our 18th- century colleagues’ position of only being able to offer placebos, laudanum, bark, quinine, the blue pill and the black pill, leeches and a slime bolus (whatever that was). OK, to be fair, we are still big on offering placebos.

But now, apparently, we are no longer supposed to prescribe antibiotics. Never mind that more than half the antibiotics in the world are poured down the necks of poultry and cattle to make them bigger, more quickly. Never mind that these drugs are available over the counter across most of Europe to anyone with a scratchy throat and five euros to spare. Never mind that the French, the Greeks and the Americans have an antibiotic ingestion rate thrice that of the UK population. We, the GPs of Great Britain, are apparently responsible for all the woes of antibiotic resistance, and must be forced to change.

I feel like Jaime Lannister in Game Of Thrones, just after Vargo Hoat cut his right hand off. Along with the immediate agony comes the instant realisation that life is going to be a hell of a lot more difficult from now on.

Incorrigible recidivist that I am, I have continued to prescribe antibiotics this last week, where I thought it appropriate. But I have also been asking patients what they thought about my reckless foolishness. Most of those I asked were aware that antibiotics are suddenly irresponsible and dangerous, but all expressed an opinion identical to my stance on public transport (yes, it’s a wonderful thing for other people… but you’re not getting me out of my car!) ‘Yes, doctor, you shouldn’t be prescribing antibiotics non-stop… but my ear really hurts!’

Technology is the answer to many of the world’s ills. No new antibiotics have been developed for decades, and the reason is obvious. Drug companies are interested in developing drugs patients will take for decades on end - statins, for example. A drug taken for five days at the most does not hold the same commercial attraction. Fix that problem and we have solved the antibiotic resistance problem.

But in the meantime, don’t blame GPs for using the best tools we have to hand.

Dr Phil Peverley is a GP in Sunderland.

 

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Readers' comments (27)

  • Vinci Ho

    The difference between Jamie Lannister and us is he was an absolutely bast**d before his hand was cut off . We are not but who are the real bas***d?

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  • Well said Phil as always. I find the zealotry instilled in younger GP's over this issue quite astounding fed of course from govt and of supported wholeheartedly by the ever P C college without considering the issues above. I was the target of a recent attempt to expel me from the practice'the 2 reasons cited being 1.I referred too many patients to secondary care.2.I prescribed too many Abx. Shows how dreadful things have become over this issue!

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  • anonymous 10.55,

    Anyone attempting to expel a GP from the practice in the current climate has clearly had a failed judgment. No wonder there is a recruitment problem. I would have expelled myself and moved on. The world is big.

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  • Phil - should have put a spoiler alert on - I haven't read that bit yet!

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  • Vinci Ho

    Don't miss GOT season 5 , starts in April . I am doing revision of the first 4 seasons on blu-ray box set.

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  • I agree with this article. If you don't know whether an infection is viral or bacterial then prescribing antibiotics will at least treat the bacterial. Not prescribing will allow a treatable infection to worsen. I saw a case of missed pneumococcal meningitis which was treated as migraine (patient aged 41 died). Maybe if the GP had been more willing to prescribe ABs it might have been different. Also this is government pressure and yet they never mention the overuse of agricultural ABs.

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  • Well, I would offer them the old 'plenty paracetamol line'........ hang on???!!! ;))

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  • It is increasingly like that line in 'Aliens' - 'Well what the hell are we supposed to use man...harsh language?' (Sorry - that was the movie geek in me...)

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  • there is a relatively cheap desk top test to help determine if it is a bacterial cause or just viral. It was discovered in 1930 and is called crp! Every Dr or NP could have one and for about £3 per strip patients can have a test to determine if antibiotic is needed. The problem is who pays for the test? Amoxil is only a few quid and they are out of your room with a green ticket to justify their sniffle and week off work. Public health complain about the overuse and microbiology the resistance developing so why not join forces with grants from the companies making the precious antibiotics to fund the change in attitude to get self testing prior to the request for antibiotics to make the whole viral conversation easier?

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  • Selective myopism is always the prerogative of government/government department looking for a scapegoat

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