The career-ending Catch 22 decision
Dr Zahid Chauhan
It’s apt that Pulse’s piece on the quandary facing GPs over antibiotic prescribing began with the word ‘emotive’, because seldom have I heard my colleagues respond to an article with such passion.
It perfectly articulated the life-destroying, career-ending Catch 22 that we may all face one day. How do we meet international clamour to reduce antibiotic prescribing, while ensuring that one misdiagnosis doesn’t cause organ damage or kill a child?
On the one hand, the World Health Organisation warns of the Armageddon scenario of the greatest health problem facing humankind, the predicted ten million deaths from superbugs by 2050.
This, it states plainly, has been because GPs are frequently bullied by a population that sees antibiotics as the silver bullet to cure all ailments, quickly.
In that, it’s partly right. The charity Antibiotic Research UK (ANTRUK) released information showing that medics are being verbally threatened and warned they’ll get an online panning for refusing to prescribe antibiotics, with over 80% also having their judgement questioned by sneaky patients who see another doctor (frequently out-of-hours) when denied the drugs.
That should enlist some sympathy. But we haven’t exactly done ourselves many favours by not taking the time to get to grips with a problem that could mean operations are cancelled due to a fear of infection. The same survey showed that only a third of healthcare professionals had a proper knowledge of the issue.
Stem the world’s biggest health problem, or chance a child’s life - what an appalling position to leave any prescriber in
But let’s not beat ourselves up too much. It takes more than a frightened GP to cause an international problem. Pharmaceutical companies driven by wealth not health continue to invest nothing in coming up with the modern medications that we need. The Government does little to properly incentivise them, save for announcing yet another strategy.
Let’s be honest - the whole of society has caused this potential catastrophe, and yet few organisations (bar the likes of ANTRUK) ask that we all solve it. Together.
Set against jibes that we ‘dish them out like sweeties’ and harsh targets to prune prescribing, we have exactly those horror stories Pulse discusses, about where broken-hearted parents overcome with grief and anger wonder: ‘Why weren’t antibiotics prescribed before my child developed sepsis?’
I share their agony. But it’s strange how the stories are never about older folks or others with already compromised immune systems. Perhaps their lives don’t matter as much?
Stem the world’s biggest health problem, or chance a child’s life - what an appalling position to leave any prescriber in.
According to one of the best authorities on the subject, Lord Jim O’Neill, diagnostics are the single most important intervention one can bring to solving antimicrobial resistance (AMR). Both he and the former chief medical officer - now UK special envoy on AMR - Dame Sally Davies, told the House of Commons Health and Social Care Committee that this was pivotal, and yet, of course, little progress has been made on developing them.
And here’s another stumbling block. What’s on the market has been denied to some surgeries by penny-pinching CCGs, which balk at a few pounds to buy the equipment, unaware seemingly, that AMR not only threatens lives, but according to the World Bank, is a direct threat to our economic future.
I think I speak on behalf of every GP when I say: ‘Take this choice out of our hands’. Stop us from having to hedge against the use of antibiotics by disseminating them needlessly and causing resistance.
But also never let us have to face families and tell them our reticence to prescribe antibiotics caused sepsis and loss of life.
Invest in diagnostics. Better still, back research into more effective treatments than the antiquated antibiotics developed before the 1980s that we have now. Because one needless death, whether by sepsis or superbug, is a death too many.
Dr Zahid Chauhan OBE is a GP in Greater Manchester; national campaigner for health equalities; and the founder of the charity Homeless Friendly charity. Follow him on Twitter @ChauhanZahid