To think Dr's are too quick to say "its a virus" go away (sensitive - maybe triggering)(94 Posts)
Apologies if there is already a thread.
After listening to the news about the poor baby who died from sepsis last year and the blame being laid at NHS 111 feet, i was struck by the fact that the poor woman had taken her child to two doctors who sent her away with her son saying that it was a virus and would be fine etc.
Of course there were failings on the part of 111 and its a service i really don't have much faith in but surely there must have been some questions over whether this child should have been prescribed anti-biotics at an earlier stage.
It may well have been "just" a virus and non responsive to anti-biotics and Drs are stuck between a rock and a hard place because of anti-biotic resistance. However, Very often bacterial infections are able to take hold because a person is laid low with a virus. Surely if a mother is returning after some weeks with a child that is still unwell, it shouldn't be dismissed as something and nothing.
I think Drs seem to have gone from a default - here have some antibiotics, which was wrong to sending everyone away with a lecture on antibiotic resistance, which can be equally as wrong i feel.
I can think of two examples (at least) where anti-biotics/further investigation were appropraite but that was not the route followed.
I went to an OOH with really bad tonsilitis - man flu (even though im a woman) and felt terrible, im usually pretty stoic and i don't remember ever being so ill. I saw a trainee GP who examined my blistered, pustulating tonsils and proceeded to give me the AB resistance lecture - the experienced GP who was monitoring him, looked at me, raised his eyes to the sky and proceeded to write me up a prescription for big gun antibiotics. I went from feeling like i was about to die to feeling much better within 24 hours. I'm not saying i would have been in any more trouble than having to suffer feeling like shit for a few more days but my illness was clearly bacterial as I responded to the treatment.
The second example - more serious, a friend of mine's child was poorly with flu like symptoms (this may not be that accurate in terms of symptoms), she was due to fly abroad to see relatives in a few weeks, she returned to the Drs a few times during this time, made to feel like paranoid parent, told he would be OK to fly. Come the day before they were due to fly, my friends son was still very poorly, worse even, so she took him back to the Dr, who called an ambulance, suspected meningitis. It turned out to be leukemia and was very nearly, too late. Thankfully this was years back and he is in full remission now, but it could have been very different.
So yes, 90% of the time, it is a virus, and we absolutely should not be giving anti-biotics for viruses, and even some bacterial infections i believe we have perfectly functioning immune systems and we should not rely on anti-biotics but if there is ANY doubt (and not just in the Drs mind - parents are an excellent guage of how poorly their child is) testing for bacterial infection needs to be offered, blood tests, swabs, whatever. Yes AB resistance is a massive problem and ABs should not be handed out like they were, but people should not always be sent away to the chemist for paracetemol either. Sepsis can occur in hours and is easily preventable.
I wonder what the statistics are of the incidents of sepsis with relation to the holding back of anti-biotics and if there is a correlation. Of course i am willing to bet that resistance is probably more of an issue, then surely more testing is the way to go. Yep, its expensive but i think its a fair use of resources.
I've just been kicked out of the Dr's surgery this morning with a 'don't be pathetic it's just a virus' attitude off the GP. Completely disinterested. I've been bedridden for 5 days. I have literally never felt this poorly. Joints are in pain. Can't stand the light. Feet are cold. Enough symptoms for me to think..hmm..could it be something else?
GP's reaction. Pff. Unless you have a rash, don't bother me.
I literally feel like I'm dying. If I still feel like this by 6pm tonight, I will take myself in a taxi to A&E. Irony being, same GP fobbed me off when I took my poorly baby in 6 months ago and two days later he was admitted with whooping cough.
Some GP's desperately need to go back to training school (no, GP, you do not have to get the rash to have meningitus) I think some of them sit there on £120k a year rather bored in their GP surgery thinking here we go again, another person exaggerating how ill they feel. Some lack compassion. Some don't listen. Some clearly do not want to issue AB's and will even cite cost. Some think us patients need to man it up a little.
Having said all of this, being a GP must be a tremendously difficult job. How do you tell the difference between someone dying of man flu (which is probably just what is happening to me right now) and someone who possibly has something more sinister at play?
The sad thing is, as parents, it's up to us to shout the loudest to ensure that we get heard and our poorly children get seen if we feel it could be more sinister. I had to fight to get my little boy admitted, encountered a lot of tut tutting along the way (wasting their time etc) until after a few tests they finally begrudgingly admitted I was right.
I think it's more common that we give it credit for sadly.
Oh god. Nearly 2 weeks ago I called an ambulance for df has he'd had diarreah and there was a lot of blood, I mean a lot. Ambulance said not an emergency call gp. GP came said it's a virus. 7 days, 2 GP visits and 4 care team visits later we finally get advised to go to hospital which ends in a blood transfusion as he'd lost so much blood. Still don't know what the cause is but he's 75 and we could have been a week closer to getting him well. I know a lot of people do waste the time of GPs and hospitals but a quick look at my dads record would show that he is generally healthy and rarely needs any medical attention.
I think the issue is that anti-biotic resistance is a massive and growing problem so GP's aren't actually allowed to prescribe anti-biotics as they were used to. In most cases this is a good thing as they were handing them out far to easily in the past.
How do you tell the difference between someone dying of man flu (which is probably just what is happening to me right now) and someone who possibly has something more sinister at play? Blood test and swabs, results back in a day or so, THEN prescribe appropriate anti-biotics.
It took me 6 months to diagnose my son with cmpa.
He spent 6 months screaming in agony, waking every hour at night for a good 30 mins.
Me and dh was sleep deprived and a complete wreck.
We went back and forth to the doctors and was told :-
Your over feeding him that's why he vomits
All babies are different. Some cry more than others
All babies get colic
It's heat rash (when the rash started showing)
They also started to refuse to see me unless I had seen my hv first.
When ds stopped eating full stop, the doctor then said a baby can go 3 days without food he will be fine.
We had to ask if he had children and would he leave his kids in this state before he finally referred us.
The hospital changed his milk and gave him medicine. Within 24 hours he was a completely different baby
It's an awful case and from what I've read in the news I think it's unfair to lay all the blame on the 111 service, though it's a service I'll probably never bother with myself as it appears that getting to talk to anyone with real medical training is very rare.
I think we have to weigh it up against the sheer number of people who turn up at the doctors with things that really are just a virus and will get better on their own, verses the small number that are something more serious.
I was fobbed off for a little while when I had repeated bouts of urinary infections. I was given antibiotics, but it was all done over the phone and I was actively discouraged from going in. I had to insist on the last occasion as I'd had four bouts in as many months and I was weeing blood (sorry if that's TMI). The gp said I'd done the right thing to come in and my wee was finally sent for testing. I was called back in, put on much stronger ab's and haven't had much trouble since. I wasn't told what the infection was, except that it was "something nasty". I do wonder what would have happened had I not pushed for a face to face appointment.
I do also know that sepsis isn't always easy to spot - a friend of mine is an experienced nurse. Her dh was ill with what she thought was flu, except it wasn't, he had sepsis. She said it was a bit of a fluke that she twigged something more serious was going on, but hadn't suspected sepsis.
I hope you find out what is wrong with your dad soon English. My mum had soemthing very similar, turned out to be internal piles which was the source of the blood and divirticulitis which is fairly common and nothing too sinister. I had called a Dr out to her, who had to throw her toys (the Dr) to get the hospital to see her, she said, "you either see my patient or I will send for an ambulance!" I have had utter nightmares with 111 in the past and now I just ring 999 or contact my mum's GP directly - she has another, separate but life threatening condition that can become dangerous very quickly - it is a rare condition so the preset questions on 111 lead us up blind alleys.
Having had a child die from meningitis (see my thread) I would just go straight to a&e if you suspect it. The rash does not always present as in my dds case until later on. Floppy high temp dry nappy unable to look at light, just go straight away. Even if you are wrong they won't mind.
I waited and saw GP and he sent us to hospital immediately but I was too late.
I agree with everyone saying that swabs and tests are the way forward in this. It's not difficult to do, and it means the right abx can be used for the infection, helping to lower the chances of abx resistance. It may mean a 24/48 hr wait for results, and it may cost more, but to me it is the only way forward to stop people dying of preventable diseases.
sugar I have read your thread and posted a response to the poem you wrote while sitting looking out to sea but then my phone must have sent it off into the ether. Was a beautiful poem and i had a few tears after listening to the lady on the radio. I think the sad thing is that, no matter how much we try to find someone to blame, often ourselves, is that these things just take hold too quickly to do anything. I don't think it would have made any difference.
The rash does not always present as in my dds case until later on
If at all.
When my nephew had meningitis he had no rash at all.
He was extremely close to death and we were all basically told to expect the worse.
Thankfully he pulled through.
Thank you Lem
My logical self knows you are right. The guilt is worse today I think because of the parents in the news and also have time off.
bubbles glad your nephew pulled through. I have heard of cases with no rash and that is something that needs to be on the NHS site.
I hate the "just" a virus attitude, it gives the idea that viruses are mild. A virus nearly killed my son.
Even though there is often no direct treatment for a virus the condition if it worsens or is severe still needs to be monitored as sometimes extra intervention and support may well be needed.
If a virus isn't clearing within a reasonable time frame then other causes, or opportunistic bacterial infections needs to be investigated.
I do think GPs are so desperate to not prescribe antibiotics that they just end up fobbing people off. They really need to find a better way to navigate antibiotic resistance and the risk of serious illness.
for you sugar
You are right about the NHS guidelines.
Its a tough job being a GP no doubt but when I see programmes like "embarrasing bodies" which should be called "embarassing GP's" it makes me as these people came to you for months years to sort this out and they have been fobbed off to have something unpleasant painfull which could have been sorted.
I've had one of mine home sick today. He has an extremely high temperature, streaming nose and rattling chest. Just tried to take him to the GP who took 17 minutes to answer the phone and then told me there were no appointments. I thrn called my private GP who saw him an hour later, was satisfied that given the number of children she has seen this week with the same thing that he has a bacterial infection and gave me a prescription for antibiotics. I'm v pleased as I know he has more than a virus
There are some truly amazing GPs and some really awful ones out there.
The tale of my DD at 5 months illustrates this. She developed a swelling behind her ear, not painful not red ( no cardinal signs of inflammation) saw locum GP probably lymph node due to virus. I work in another clinical setting thought this was entirely reasonable.
5 days later she was still well, no temperature just if you brushed the lump she seemed uncomfortable so thought it warranted recheck. Got an appointment with GP registrar he was uncertain tried to get senior partner who was with terminally ill patient so ended up having to consult with same locum who said oh this baby just give it antibiotics, did even examine DD.
Locum left GP registrar sat there for a minute then said "I'm sorry if I'm going to waste your time, but I'd really like you to go to paeds assessment unit. If they said you home with antibiotics I'm really sorry, but I just feel she should be checked'. I happily went due to his gut feeling.
I bless him every day for trusting his gut as his actions saved her life she had a mastoid abscess and sepsis, but none of the normal signs. She was the first case of mastoid abscess in 25 years in a baby under 1 year.
I am a very measured person I thanked the GP registrar in a letter for saving my babies life and asked him to always trust his gut. The locum never worked in the practice again.
I think some GPs definitely need better training. As you've stated though, they do a very difficult job and inevitably, they will sometimes make mistakes. Sometimes, it is only time that will tell whether something is serious or not. They can't send every case of flu to hospital just in case!
GPs are trained in how to 'safety net'. This means they will say something like: if the temperature does not come down with paracetamol, if the nappy is dry, if you are worried, please come back/go to A&E. This is an exercise in communication that is not always perfect though - the GP doesn't say it in the right way, or the patient does not understand. Again, although training could probably be better, misunderstandings are not always avoidable.
Ebola is a virus and nobody has ever, ever thought of it as 'just a virus'
Trust me, any doctor worth their salt is well aware and very fearful of the suddenness in which sepsis can strike and kill - in particular babies and young children (also the elderly btw).
'Just a virus' does not imply you cannot be utterly miserable and properly ill, it just means an antibiotic is not going to make a difference.
Viral meningitis kills and disables.
Chickenpox related encephalitis ditto.
Bronchiolitis in infants can be an emergency - caused by a virus.
Children's condition changes quickly. And reassessment is often needed.
funandgames your post is a great example of what happens in a private healthcare system. The patient becomes a 'consumer' and the doc gives them what they've come for, regardless of whether it is necessary. That one consultant probably cost you most than your regular GP is paid to be available for you all year.
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