To want our doctors to give us medicine?

[ditziness]

Have two kids, 11 month baby and 4 year old. DH and I got ill 3 weeks or so ago, sore and tight chested, sore throat and ears. Kids started getting it too a week after. DH went to doctor on own and got antibiotics for a chest infection. Me and kids go day after, but apparently no antibiotics needed, we've all got a virus. Meanwhile DH is fighting fit within a couple of days of antibiotics. A week later me and the kids still coughing and rotten, surviving on paracetamol and calpol, not sleeping well . On my knees really. So back to doctors, but still no antibiotics . Apparently still a virus. That DH bizarrely hasn't got.

AIBU to think they should just give us antibiotics?

[Sarah919]

Gales, GPs get about £60 per patient per year to provide all their medical care. Good luck finding unlimited GP care for that price in the private sector.

[Gales]

I have never ever treated my own GP with anything but the utmost respect macdoodle (and I visit him about once every three years between me and 2 DCs), but then he has never spoken to me with the contempt you have demonstrated for your patients here.

If you're happy, that's great , carry on.

[macdoodle]

And more, after tax/neccesary expenses/childcare, my take home pay, is probably about £17/hour. Hmmm actually remind me why I do this again.

[Lucyellensmum95]

I thought this thread was about anti-biotics

[midnightinmoscow]

I am PMSL'ing at all the amateur GP's/microbiologists/virologists on MN.

Yeah, so you had some phlegm in 1998 - that makes you an expert.

Oh, and of course people only become Drs to deny patients treatment, piss them off and generally make people's lives miserable.

tru fax

[macdoodle]

would never speak to my patients (not customers) other than with utmost politeness and respect. Sadly they do not all return this. However, the disdain and dismissal of the years of GP training and experience expressed here always makes me annoyed. Hence why I disappear for long periods.

[Sarah919]

I think lots of people genuinely think they could be a a GP tomorrow. It's astonishing. What do they think the 10 years of training are for? I'm interested what clinical signs the posters with the confidence in diagnosing bacterial infections base their diagnosis on. Do you actually know the clinical signs that help distinguish between a viral and bacterial infection? What are your findings when you auscultate your own chest? Do you use the Centor criteria when you have a sore throat to decide if you need Abx? And what's this magical 'test' the GP can do to immediately differentiate a viral from a bacterial chest infection?

[landrover]

Strangely enough. if i took my dog to the vets with these symptoms (they would see him the same day obviously!} The vet would happily give me a weeks antibiotics and free return check up!!!
They have never yet said he has a virus, go home! Amazing how animals get treated better!

[currentbuns]

My dd had the symptoms described in the OP a couple of weeks ago, as well as a sporadically high fever. Our GP wasn't available so we saw a locum at the surgery, who prescribed AB.
Four days later, the symptoms remained unchanged, so we took her back to the surgery, on this occasion to see our usual GP. He said it was almost certainly a virus, which is precisely why the AB hadn't worked. He rarely prescribes AB in any case.
As an aside, my DB is a GP and is forever lamenting the age of self-diagnosis wrought by the internet :)

[macdoodle]

landrover how much exactly does your vet charge for this pleasure. I know my cats last infection cost me upwards of 3 figures!
Hahahaha when you pay that for a GP consult plus the overpriced meds on top, then you can have whatever the fuck you want the wrong treatment

[macdoodle]

In fact the last time my cat had a mucky eye, the vet told me it was a virus, and then prescribed me antibiotics . Super.

[AnyoneforTurps]

" The vet would happily give me a weeks antibiotics and free return check up!!!
They have never yet said he has a virus, go home! Amazing how animals get treated better!"

Oh for the love of god: prescribing antibiotics for a patient (animal or human) who cannot benefit from them is not treating them better. It is putting them at risk of serious harm for no benefit.

Trust me, my life as a GP would be 7 million times easier (conservative estimate) if I just prescribed antibiotics to everyone who asked for them. Do you think I like arguing with patients? It would be so much quicker and easier just to write a prescription.

I don't prescribe antibiotics for infections that I believe to be viral because:

1. THEY DO NOT WORK FOR VIRAL INFECTIONS
   
2. THEY CAN CAUSE SERIOUS HARM
   
3. I WOULD LIKE YOUR DC TO HAVE ANTIBIOTICS THAT STILL WORK WHEN THEY GROW UP
   
   The selfishness of some posters on this threat makes me despair. Don't you care that your kids may die in their 30s or 40s of infections that are easily treatable now because antibiotics will no longer be effective? Do you really want GPs to squander the precious resource of antibiotics on minor self-limiting illnesses today, at the expense of the next generation? Because that seems monumentally selfish to me. And if you think I'm exaggerating the risk of resistance, check out this link.

[TurnipCake]

When I was a medical student, I sat in with a GP who dished out antibiotics like they were sweets. I saw a lady who had all the signs and symptoms of a viral illness, spoke with the GP supervising me, she agreed it was a viral illness but said to the patient, "Do you want some antibiotics anyway?"

Patient prolly walked away happy, but it's lousy medical acumen.

There are vulnerable groups who rely on antibiotics to work, and continue working for as long as possible - a self-limiting viral illness can be prolonged and miserable, but it's self-limiting in normally healthy individuals.

[LessMissAbs]

No idea how long, with many different types of pneumonia, both bacterial and viral, I would expect it to vary widely. In our child's case it way an atypical infection, ie a bit harder to spot on initial symptoms, but there was something not quite right and with friends too, it took me a week to react, GP picked up right away the indicators, first GP visit in 5 years and only second ever visit for illness and not vaccines, so not much medical history to go on, had chest x-ray and antibiotics in 24 hours, blood results in 48 hours, risk analysis to keep at home as IV antibiotics not needed, took 4 further weeks before the funny sound on breathing to finally go away and seem 100% recovered

Just to reply to reluctantmover, my experience with pneumonia is that I visited my GP who said it was viral and missed it, and out of hours service which diagnosed pneumonia and prescribed penicillin. This took 8 days from first feeling ill. Unfortunately the penicillin didn't work, back to GP (had to get a taxi there as incapable of standing to wait for bus) who said it normally took a while to recover and did nothing, then collapsed in agony two days later and called ambulance which took me to A & E where I was admitted and treated with antibiotics intravenously. I had a month off work and the first month back after that I was pretty useless.

This was all despite me having exercise induced asthma and telling my GP that my DH had just recovered from pneumonia!

[AnyoneforTurps]

lessmis Sorry to hear about your experience, which demonstrates why it is always important to reassess patients who are not getting better...


but...

...you recovered because there were antibiotics available to treat you. Imagine what would have happened if there had been no antibiotics that still worked. Before the 1940s, young fit people regularly died from chest infections because there were no available treatments. If we do not tackle antibiotic resistance, that will soon be happening again. Resistance is increasing terrifyingly fast. This is a really huge threat to health and everyone - patients and GPs - must treat it very seriously or people like you with major illnesses will die. Don't take my word for it - more info here

If GPs dish out antibiotics to every illness in its early stages, on the off-chance that it will develop into something serious, there will soon be no effective antibiotics for many common infections. Bacteria are incredibly clever at adapting and can even learn from each other how to become resistant.

So a responsible GP does not dish out antibiotics if an illness is likely to be self-limiting but does tell the patient that it is important to come back if she is getting worse or not improving. If there are signs that a bacterial infection is developing on top of a viral one, antibiotics can be started at that point.

[LessMissAbs]

Oh don't I know it, AnyoneforTurps. I like to think I survived because I'm young and healthy too, but I have never felt so close to death. The sheer effort it took me to get in that bloody taxi, sit and wait for the GP to see me, only to be dismissed, while I hardly had the strength to stand!

I do think young, healthy people get overlooked when antibiotics are being handed out. When it boils down to it, GPs are simply following current government guidelines on prescribing.

And yes, as for long hours and (relatively) poor pay, plus practising certificate costs, that applies to any traditional profession. Plus the long training, yet I'd be the first to admit that in my field, a lot of it, unless you are a top and specialised practitioner, isn't actually rocket science, and the reasonably intelligent lay person can understand it if they read about it.

[LessMissAbs]

That BBC article you link to, Anyone, its a bit "aimed at the proles", isn't it?

The bit titled "Sexy Time", its hardly news that bacteria multiply quickly and everything composed of DNA can mutate by conjugation with alleles from related species. Its been going on for millennia. Is over-prescription of antibiotics in India really that rife? And it would lead us to believe that penicillin tackles all bacteria, but surely everyone knows that there are other antibiotics available which work on the protein synthesis of bacteria, such as tetracyclines and macrolides. Is this considered "resistance"? You could equally point to a couple of UK recent cases of Lyme Disease, which were inadequately treated by antibiotics and in one case resulted in death.

Surely the problem that's not being mentioned is that too few new antibiotics are being developed to keep up with bacterial reproduction, because its just so damned expensive to put them on the market and test and license them, and so the system we have created is not encouraging research to keep pace with disease. Not prescribing antibiotics is akin to putting a sticking plaster on a wound that would be better sutured.

[Sarah919]

Which of the traditional professions do you work in then LessMissAbs?Because you can't just 'read about' medicine to practice it. And compared to the other tradional professions, medicine is definitely less well paid. That's explained on the first day of medical school to weed out those who think otherwise, as the saying goes you should never do medicine for the money. Other professions may start off badly paid but a lawyer for example at the top of their game, comparable to an experienced GP, will not I imagine be taking home £17 an hour as per the GP up this thread.

[roundtheback]

Bacteria multiply quickly: no it is not news, it is an explanation of why they have a selective advantage over us.

Is over prescription of antibiotics in India really that rife? Good god yes. The Indian subcontinent is the origin of extended-spectrum beta-lactamases and carbapenemases. Sadly these are now circulating worldwide, including in the UK.

Tetracyclines and macrolides: have their uses but they are limited. Tetracyclines cannot be given to kids or pregnant women. They are bacteriostatic hence not much use for the immunocompromised. They aren't really suitable for any very serious infection. Macrolides don't have activity against Gram negatives, which is where the most pressing problems with resistance are. And staph and strep resistance to them is not all that uncommon.

Penicillins: as a group are broadly speaking the most efficacious antibiotics. If I had a serious infection I would want to be treated with a betalactam. People with serious infections that are resistant to all betalactams, or who are genuinely allergic to them, are at a survival disadvantage because the alternatives are less effective.

Not prescribing antibiotics is like a sticking plaster: absolutely not.

It may not be rocket science but there is much more to it than you seem to think. I wish it wasn't the case, but it is. I deal with this every day and it is not scaremongering.

[Sarah919]

Yes the sticking plaster analogy is way off. Are you saying doctors are deliberately not prescribing antibiotics for obvious bacterial infections? Why would a doctor do that? As said before it's much easier to hand out antibiotics than educate patients about viral infections. Giving abx for a viral infection is more like putting steristrips on a minor graze, it'll get better either way, people just think the abx have cured it when it would have got better itself anyway.

[sashh]

OP

I don't think it's a case of you not being treated because of a different Dr, I think it is the fact that DH is asthmatic.

I had a chest infection last year, left it the ten days before seeing Dr and I was told off because I have asthma and should have been seen sooner.

I currently getting over another chest infection, for which I have been given antibiotics, not because of the actual infection but because I have asthma and if it is bacterial they want to get rid of it ASAP.

I do feel for you, it must be so difficult being ill and looking after children who are ill.

[CouthySaysEatChoccyEggs]

Any cough or sore throat lasting over a week and a half - 2 weeks, and I insist on swabs being taken now, since the GP misdxd DS1's erythromycin resistant strep throat that lasted 6 weeks in total as 'viral'.

It only cleared when he was given the right AB's.

Two weeks of no AB's, 2 weeks of erythromycin (no penicillin / Amoxycillin as DS1 allergic), and finally 2 weeks of something else before it was bloody clear.

OP, YANBU. If I were you, I would now be insisting on swabs.

But I'm mardy!

[CouthySaysEatChoccyEggs]

Reluctantmover - I'm sure you do realise that 'strep throat' isn't always an innocuous illness that doesn't require AB's? And I'm sure you know that strep throat can result in a systematic streptococcal infection causing complications?

My DS1's complication ended up being appendicitis...

[Sarah919]

Strep throat doesn't cause appendicitis, do you mean adenitis? The OP's symptoms don't fit with strep throat, which is generally self limiting anyway after about 5 days. Abx just reduce the length of symptoms for about a day or two and complications. Don't forget some people will carry it anyway so clinical findings still need to fit.

[UptheChimney]

YABU

And it's people who think like you who are contributing to the decline in the effectiveness of antibiotics.

Just as selfish and short-sighted as those who thought they knew better than their doctors and didn't vaccinate their children --so now there's a threat to herd immunity.