One thing that strikes me as we wade through the treacle of increasingly perplexing abbreviated patient scoring systems (CHA2DS2-VASc, HAS-BLED et al) is that the bread and butter areas of medicine are being left out.
Where, for example, are the helpful scoring systems to help us decide whether a sniffly punter needs antibiotics? Here, that’s where. Because, as a service to grassroots medicine, I have devised AMoX5ORNOT, a scoring system devised to work out the risk to the patient of not having an antibiotic, to be used in conjunction with F3-U DOCT2AH2, which works out the risk to the GP of not prescribing an antibiotic.
This is how it works: the patient presents with cough and requests antibiotics – should I prescribe?
First, work out the AMoX5ORNOT score:
Already running half an hour or more late +1
More than two visits still to do +1
Expectorated phlegm colour – sliding scale of greenness thus:
Pistachio +1
Shamrock +2
Olive +3
Teal +4
Glow in the dark +5
Waiting room packed +1
Friday evening +1
Not given many antibiotics so far today, so feeling pretty smug +1
Possible total AMoX1-5ORNOT score 10
Next, work out the F3-U DOCT2AH2 score, as follows:
Football shirted (+2 if no shirt at all, +3 if no shirt in winter) +1 to +3
Patient Unlikely to be impressed by your talk about the self-limiting nature of viral illness +1
Double negatives used by patient (eg ‘The other doctor didn’t give me nuffink’) +1
Neck size >18” +1
Tattoos visible without undressing patient (+2 if ‘Cut here’ tattoo on neck) +1 to +2
’Always’ used in presentation (‘Always goes to my lungs’ or ‘Always need antibiotics’) +1
Head shaved (+2 if woman) +1 to +2
Possible total F3-U DOCT2AH2 score 11
Finally: look at the two scores. The higher the AMoX5ORNOT, the greater the likelihood you’re going to need to prescribe antibiotics. And the higher the F3-U DOCT2AH2, the greater the likelihood that your face will be rearranged if you don’t.
Alternatively, you could go with your gut GP instinct. It’ll amount to the same thing.
Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield
