So apparently we’re supposed to give up on NICE-advised ‘delayed’ antibiotic prescribing when a patient wants to try a course of miracle-cillin for their dreadfully bad cough. What? And miss out on all the fun I have handling phones calls from irate local pharmacists who are trying to explain to irate local patients that they can’t dispense a prescription today if it’s got next Tuesday’s date on it? Which part of ‘delayed’ didn’t the patient understand, I wonder?
To a man, my patients are high-flying double-busy go-getters who don’t have a lot of time for deferred gratification. They want their appointments now, their prescriptions now, their referral letters now and their whiplash compo cheques now. The ‘watchful waiting’ concept is lost on them, unless the alternative is painful prostate surgery with a chance that Mr Stiffy might transubstantiate into Mr Floppy in the bloody aftermath.
Instead of teasing people with post-dated prescriptions the plan is that we simply give the patient a quick yes or no as the mood takes us. Which would be fine if I ever actually said ‘no’.
Don’t get me wrong and bundle me in with the cowards amongst you who defer to every patient’s every request. I tell patients if prescription drugs aren’t likely to help, I appeal to their sense of reason, their faith in me as their trusted family doctor, their ability to understand basic scientific concepts like the difference between a bacteria and a virus. Honestly, I’ve been known to devote upwards of 90 seconds to the debate. Or monologue, to be more accurate.
But after all that good work and devotion to duty, if the idiot patient refuses to leave the room empty handed, I cheerfully hand over a prescription for massive doses of erythromycin and metronidazole, mention something sotto voce about diarrhoea and alcohol, and enjoy my evening in the pub wondering whether they’ve succumbed to the splitting headache or the explosive diarrhoea first.
Come on. When else do we get the chance to do something, anything, with an infinite risk/benefit ratio, that has no possibility of helping a patient in distress without running the risk of being sued? In fact, they even love us for it.
An American friend of mine is fond of quoting, ‘Some patients deserve the physician of their own choosing’. To which I would add, ‘and their prescriptions too’.