for being really fecked off with GPs(135 Posts)
I understand that antibiotics do not work when you have a viral infection.
However, last week DD2 (15m) was clearly not right. I called GP and told them her symptoms (sleeping 17+ hours, bad cough, high fever, not eating). They told me (over the phone) that it was a virus. Wait it out. I waited 2 days and took her to see a private GP who immediately diagnosed her with a chest infection and prescribed antibiotics.
My SIL has been sick since end of last week. She is getting progressively worse (same symptoms as above other than sleeping!). She phoned GP Monday. He told her (over the phone) it was a virus, take paracetemol and wait it out. It got to the point that she felt her chest tightening and heavy so went in the next day (yesterday). He acknowledged that she was quite ill, but gave her an inhaler and said it wasn't an infection. She's worse today than she was yesterday and is now going to see a private GP.
Last winter my DD1 had persistent high fevers that did not respond to calpol or neurofen. We were in A&E twice and dr twice. Every time, "it's just a virus". After 6 weeks I had enough and took her in and said I wanted her to have blood tests as I was convinced she had cancer. Funnily, they gave me antibiotics even though "there is no sign of infection" and within 3 days the fevers were gone and have never returned.
Also last winter my then 5 week old baby had a high temp. I took her to the GP. "Just a virus". Next day, same thing and on call dr had us go straight to A&E where I was told "it's just a virus". Luckily a very good consultant was on call and thought it would be wise to do a chest x-ray "just in case". She had PNEUMONIA.
I understand that there are worries about antibiotic resistance. But what is the point in withholding antibiotics until one is so sick that there is no other option? In all of the above examples, antibiotics were or are currently being withheld needlessly. Why?
And DD's pneumonia was just a cold 48 hours before. Infections and viruses can set in very quickly and unpredictably.
It's not all guesswork between viral infection versus bacterial either - tools like Centor criteria are used for tonsillitis for example.
A chest infection is a chest infection. Doesn't matter whether caused by a virus or infection. It is now an' infection'.
However, most chest infections in adults will be cured by their own immune systems within 4-6 weeks. People with immune disorders will probably need help with ABs.
I've had some terrible chest infections after bugs which caused high temperatures. I always waited as long as I could, but sometimes did get ABs from GP as was really ill and went on for too long, and they worked.
Testing huge numbers of people with (mostly) self limiting illnesses would be a massive waste of nhs money, when clinical experience and knowledge of most likely bug is usually sufficient.
You have had a few bad experiences though, telephone diagnosis has risks though, and I hope anyone doing it says come in if it doesn't settle, no drs have crystal balls sadly!
UK NHS GPs practice evidence based medicine, there are guidelines to follow but its not as simple as following a protocol, it takes clinical experience and judgement. Withholding inappropriate antibiotics is not a money saving exercise, it is a safety exercise and as a dr I am responsible for my prescribing.
As other posters have said, being diagnosed with a viral illness is not the same as being dismissed, ignored or fobbed off. Viruses can be serious, but antibiotics will still not work (unless a secondary bacterial infection occurs, and this is by definition a few days later). The treatment for most viruses is supportive (fluids, temp control) and this can be done at home without a prescription.
Telephone consultations certainly have a place, but I always ask young children to come in for an examination.
Erm your SILs case is just bronchitis which is mostly viral and will get better of its own accord even if it is bacterial (otherwise before the invention of ABs no one would ever have reached adulthood). Even if your private GP gives her antibiotics the antibiotics will probably not be what makes it better. It will get better anyway and the fact that she takes ABs at the same time will be a coincidence.
I get bronchitis 3-4 times every winter. A hangover from childhood asthma. It is knackering and very unpleasant so I do sympathise with your SIL. Maybe some of my bouts would clear up faster with ABs. But I wouldn't dream of taking them just to find out because I am young and healthy and will recover just fine without them.
Antibiotic resistant bacteria kill people in large numbers and they are going to kill more and more people in the future. Mainly older people who are already a bit frail and young babies whose immune systems are not mature enough to cope without them. Babies like your DD when she had pneumonia last year...
Add to this mix the stress most people are feeling about their employment security and it's really very toxic. No one wants to be ill for extended periods when the axe is swinging at work.
Why do you presume that the doctors who gave the antibiotics were the ones who got it right? I can see that in the case where the baby had a CXR that showed achest infection antibiotics were indicated but the others just sound like one doctor's advice v anothers.
Viral illnesses (and most bacterial upper respiratory infections) go with time. It sounds as though the infection was just nearing the end of its life when you got the antibiotics.
I agree that private GPs want you to come back so are more likely to give antibiotics whether you need them or not. If you want antibiotics every time you get a temperature stick with the obliging private GP, just don't be surprised if you get a serious bacterial infection and it's antibiotic resistent.
Where did the "viral illnesses usually last a week" myth come from. There are many viruses, cold viruses, flu viruses, the polio virus, AIDs, chicken pox and they all last different lenghts of time.
I think if you have a respiratory infection for over a week it's wise to see your GP, but if she says it's a virus then why not believe her and just review things in another week?
Why all the trips to A&E rather than the GP as well?
Viral illnesses usually last a week
No they don't. They can follow different patterns. Some viral illnesses can last 4-6 weeks.
I absolutely do not like to give my kids (or myself) antibiotics. They cause a whole host of problems while treating infection. Saying that, if there is a clinical need for them then I do not think they should be withheld to "wait and see".
I do not believe for a second that I have given them to my kids (the very few times) needlessly. In the instance of my dd last year who had ongoing fever for months, we were directed to a&e twice by NHS direct, and when I took her to the GP months later I asked for blood tests, not antibiotics. Antibiotics is what I got because guess what? That's the cheaper option.
I agree with you, I have terrible experiences with NHS GPs (not all, but by far too many).
No, private doctors don't give you just what you want, but they use their skills to get to the bottom of things and money is less of an issue.
My dd nearly died due to the negligence of an arrogant GP. She had life threatening pneumonia in both lungs - she was basically drowning and the GP for a whole month having fobbed me off saying it was just a virus with weeks of 40 degrees fever not responding to medication and telling me I was over anxious, wasting precious NHS time and that I would be struck off it I dared to bring her in again with the same symptoms - that was the afternoon she was blue lighted to hospital as she had stopped breathing and had sats of 85 and now has severe scarring of both lungs)
Second time round, similar symptoms we went private. Paediatrician checked her out, took temperature, took her SATS, ordered an X-ray on the spot - diagnosed pneumonia and treated it, checking her every three days to check she was responding to the antibiotics. V. expensive, but well worth it for us.
Now in the Netherlands she became ill, similar symptoms, GP straight away ordered X-ray at local hospital as was concerned about her SATS (95). She mentioned that SATS and respiratory rates are good predictors of presence of pneumonia and that she wanted to positively exclude it through an X-ray rather than prescribing heavy duty antibiotics just in case.
So I do think that some NHS GPs are just incompetent/uncaring, but many are probably just trying to control their budgets.
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My friends son was fobbed off for months by their GP and he had leukemia. People need to educate themselves. Persistent fevers and weight loss need investigating. And we're talking it all starting in December and me requesting further testing in march. Hardly an overreaction on my part.
Here we go again, doctors obviously are always right about virus s. That s the first thing they say, coz that will get rid of you for another week!!!
They did that with my 14 month old daughter, 3 doctors all said she had a virus, 3 consecutive days, but hey !!! it was sorted, she died the 4th day from meningitis !!! I would demand antibiotics every time, im sorry if you all think different but what gets me is that gp s take no notice of the fact that you know your child best!!!!
Bacterial infections are often secondary, and GPs do not have a crystal ball.
Instead of going from a telephone appointment to a private GP appointment why didn't you just ask for a face to face with your NHS GP?
If you had multiple instances of being seen by different doctors within the same hour and getting different diagnoses then I'd agree with you.
But illnesses are dynamic and can change quickly, particularly in young children.
We are veterans of GP/hospital/Ambulance circuit thanks to dc's underlying illness, and you have my every sympathy because watching them ill and having the responsibility of having to deicde when to take them in is stressful. No doubt about it.
But, you seem to be misunderstanding about illnesses and how they affect the body... Which is probably why you see a doctor!
I'm very sorry to hear about your daughter.
Thankyou Sue Flay xxx
Ten years ago now but doctors still missing the signs of meningitis, not always a rash unfortunately xxxxx You bury the pain and then an op comes up with this and brings it all back xx
dikkertjedap can you explain the Netherlands system please? It sounds better than ours. I assume it's basically free at the point of use?
The difference between the private GP and the NHS one that saw your DD was that the private one actually saw the patient. If you want treatment for a cough you would need to actually see your doctor in person so they can listen to the patient's chest. They aren't likely to prescribe antibiotics over the phone unless you have a medical history that warrants them.
Saying that, if there is a clinical need for them then I do not think they should be withheld to "wait and see".
You are not the person who decides clinical need though. You did not train for 7 years at medical school. That's not to say that GPs don't fob people off but you sound very dramatic.
i am worried about pnemonia,
how do you know when to call docs with baba? has a nasty chest, how long do we wait for?
Rose - you need proper advice from a medical professional, not MNers, however well its meant.
How about ring NHS Direct or do you have a local Walk in Centre?
Rose if your worried then seek help its always best to have things checked out. With DS he is prone to pnumonia so i know when his temp goes up chances are that is what the cause is unfortunatly.
Lady - I have only just moved here, so don't know the system extremely well. The only thing I know that it is hugely expensive, apparently it is even more expensive than the US. Everybody is obliged by law to take out private health insurance, the rates for the basic insurance is set by the government and government also determines what is included. There is quite a high excess charge which applies to all insurances as it is also determined by central government.
However, it is very easy to get an appointment, even at short notice.
Hospitals look very clean and airy and waiting times seem quite short. However, there are horror stories of doctors not washing hands and unnecessary surgery so they can earn more (so it is not all good!).
So far, the service we have received here is comparable with our private paediatrician in London and clearly a lot cheaper than the Portland Hospital.
We had terrible experiences with the NHS I am afraid. Uncaring and incompetent staff not just on one occasion and in just one place but on many occasions in different places. I find that NHS GPs are more budget driven than patient oriented.
Rose a lot depends on the age of the child. Key indicators are fast and laboured breathing, not very responsive, bluish lips and nails, coughing but not always, etc. etc. and child doesn't need to have all these symptoms.
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