To think GP’s are meant to be lenient with prescribing antibiotics?

[Gem123J]

My DD (4 years old) woke up this morning with a headache, checked her temp and it was 38.6 so gave her calpol at 8am. Couple of hours later she was still complaining of a headache and said her forehead was hot so checked her and she was 39.3 so gave her ibuprofen at around 11am. Checked her temp again before we left the house to go for a walk and she was 38.6 and was happy in herself so we carried on with the walk. While on the walk she was totally fine, happy and running around playing “monsters”! We went for a drive and around 3pm she was very pale, lethargic and just wanted to cuddle and wasn’t herself at all, checked her temp and it was back up and was now 40.1 so gave her calpol and decided to call 111 because she was also complaining of sore throat, headache seemed to be bothering her more because she was wincing and she was also complaining of belly ache, her tonsils look inflamed too. We stripped her down and had a call back off the triage nurse, then the GP and was told to come in for an out of hours GP appointment later in the evening. While waiting for the call back her temp went up to 40.2 and we gave her ibuprofen at 5.30pm.

She didn’t want anything to eat but she did manage to drink and had 2 of the baby cucumbers but didn’t want anything else. Her temp went down with the ibuprofen like it had done earlier. She perked up a bit before the appointment and her temp went down to 38.6 and the GP checked her lungs, checked her ears and her mouth but didn’t seem to be concerned about her tonsils and just said it’s most likely viral.

I am obviously a bit concerned because her temp had got so high even with alternating calpol/ibuprofen every 2-3 hours (we were told to alternate off her GP last time she had a high temp that was still rising last year). And there have been local cases of strep a and I thought that GP’s were told to have a low threshold for prescribing antibiotics because viral and bacterial infection symptoms are indistinguishable in the very beginning.

Obviously I’m going to keep a close eye on her tonight but it is a bit scary when you read stories of children who were told they had a viral infection and were seriously ill a few hours later. My friend took her son to their GP last week and was told he had a viral infection, she wasn’t happy with the response and had husband to take him the following day and they swabbed him and prescribed antibiotics and it came back as strep a. I know not all cases are fatal but should I have pushed for the GP to take a swab? All he said was keep an eye out and if she still has a high temp in 5 days to take her back. Has anyone experienced the same thing lately?

Obviously if I thought my daughter was seriously unwell then I wouldn’t be waiting around, it’s just crazy how one minute she looks absolutely awful, but perks up and looks like a different child the next and is just up and down like that!

Why ask if you're being unreasonable when you won't entertain any suggestion you were? So tedious.

@Gem123J - I understand you are anxious and I think you did the right thing in seeing the GP.

It’s a lot easier for clinicians to just prescribe antibiotics. It reduces their worry and stress too. But it’s not necessarily in the long term best interest of the patient or population to do that (thrush, diarrhoea post antibiotics, resistance etc). It’s harder to examine carefully and use clinical judgement to come to a reasoned, evidenced decision. Clinical judgement is mentioned in most guidelines (strep an included) - which is why it’s not a tick box exercise that anyone/computers can follow a flowchart to do. GPs have gone through a 3 year specialism on top of junior doctor years (and many will have additional experience too). And you should be reassured that when the gp saw your child, they did not show worrying features (enough to reach the threshold for antibiotics - maybe there wasn’t pus on the tonsils or skin didn’t seem pale/mottled).

It’s impossible to pick out ALL the rare severe cases early (sometimes only time will show which ones get better/worse) - which is why you need advice to continue monitoring - and seek further medical advice if patient doesn’t improve as expected or deteriorates further. But this is a far better system overall than to either give everyone with a sore throat and temperature antibiotics or refer them to the hospital paediatricians. I hope your child improves and feels better soon.

You obviously don’t think you’re BU, so why ask? It’s tough when your kids are ill. Viral infections can be serious and horrible - has covid taught us nothing?!

Oh dear, maybe your are not the skilled doctor you think you are, longing for the good old days when patients did as they were told 😂. As you have noticed, times have moved on and to be an efficient doctor, you move with the times so that you skilfully treat actual 21st century patients, not some imaginary victorian patients who defers to your imagined 'authority'. Interestingly, I have seen GPs google conditions and give advice based on what they find on nhs.uk. Google usually takes you to nhs.uk when you search for symptoms in the UK. It's sad that lots of doctors have rubbish communication skills and a superior attitude but luckily some medical schools focus on this as an integral part of a doctors education. After all, what use is all your knowledge and expertise, if your patients don't follow doctors 'orders'? NICE have specific guidelines on shared decision making and enabling patients to actively participate in their care. Most medics expect that patients have googled their condition and don't bumble into the surgery without having a clue about their symptoms. Funnily enough, the NHS actively promotes the use of digital resources such a 111 online (which could be much improved) so clearly digital information and decision making is part of NHS strategy. A good contemporary doctor can manage a google informed (or uninformed) patient without being all tired out and irritated by it.

🤦🏼‍♀️ I despair.

Of course patient choice matters. Who said it didn’t?!

However, Patient diagnosis and questioning of GP treatment suggestion, when the patient has not even followed basic advice on how to treat a (likely) virus and who simply wants AB’s because ‘my friend’s son got some’ is really not up for consideration.

What a nasty post. If you can do such an amazing job and never be tired or irritated. Am well and truly sick and tired of people on the Internet thinking they know better than a doctor while at the same time thinking it's so easy and well paid. Then why didn't/don't you do it? There's a shortage of doctors (and all HCP) for a very good reason.
And yes of course most times "doctor does know best" that's what all the training and experience is for. I dont question my mechanic, electrician, plumber etc etc for very good reason.

FunnyBauble Don't take out your inferiority complex and problem with authority on Quincythequince. She's a doctor, she knows more than you. Get over it.

@ArmWrestlingWithChasNDave is she a Doctor though? I could also claim to be a Doctor on Mumsnet if I wish! If she is, she definitely isn’t a MH doctor or Paediatrician 😂

YABU.

GPs being “told” (more like ‘advised’) to be more lenient with antibiotics does not override our decision not to prescribe after our clinical assessments.

Actually my guess is that Quincy is a paediatric consultant 😀

No, I am neither of those.
Who said I was.

And anyway, how does telling someone that they are ring to assume GPs should be lenient with anything, give any indication of specialty.

It doesn’t of course, unless you think you can tell a GP what to do because you googled it and then argue with them, when is not what you want.

@Quincythequince
I never said you were any, just a bit of sarcasm!

I do think you are very narrow minded though. From what I’ve read OP never told any GP what to do because of what they had googled nor did they mention anything about arguing, or even disagreeing with them.

I totally understand why OP would be concerned. They didn’t want antibiotics just because it was their opinion that they should have and that others have had, just that they thought they had read that Doctors are being more cautious and are prescribing antibiotics for less severe cases as before. And because many are being told that their child’s illness is viral when a few days later it turns out it was in fact bacterial.

It is a dangerous game telling someone they were wrong in seeking medical attention just because that is what you believe. OP is right in following guidelines rather than what some ‘maybe’ Doctor, because who really knows on Mumsnet, is having a go at them for.

Bit rich of you to lecture Quincy for that when the OP has seen a real life doctor then came on Mumsnet to ask for layman opinions.

Lots of Dunning Kruger in this thread.

@ArmWrestlingWithChasNDave

then what is Mumsnet for? It’s a forum, you and @Quincythequince seem to take this a bit too negatively and too seriously. What is wrong in asking the opinion of other Mums without being judges so harshly? It seems some come on this forum purely to bash other people who think differently to them or have reacted differently to how they would react. The word ‘trolls’ come to mind!

That went over your head huh! You're berating Quincy for giving her view when she might not be a real doctor, when the OP saw a doctor then came on here to ask Mumsnetters for their view.

The one "bashing" (are you 12?) is you.

@Quincythequince you said yourself that you had not seen any of the guidance that OP was referring to. It was pretty clear that you were primed and ready to give your stock response to the age-old problem of people demanding antibiotics as a general cure-all for all cold-type illnesses, with a hefty side order of disdain because surely everyone knows by now, right?

When she pointed you to the guidance, which was from reputable, impartial sources and was issued recently and specifically in relation to a current public health concern (StrepA), you could have been gracious and said “Ah, OK, now I see what is behind your question. I’ve now looked at that guidance and perhaps I can explain what is meant in practice by “a low threshold”.” Then you could have explained the GP’s likely thought process, without telling her she had failed to administer basic care and implying that she had been impudent to question the authority of a doctor.

But that would have been too nice I guess. I mean, it’s not like it’s the season of goodwill or anything…oh wait..

I didn’t say she was wrong seeking medical attention. Not once have I said that.
Stop making things up.

I have thick skin and these petty insults don’t even resonate with me. But I tell you what, I really feel for my GP colleagues having to put up with utterly nonsensical pushback like this for no good reason - day after day.

Go and tell your mechanic or builder exactly what should be done for a job you’ve given them and see what they have to say about it.

@ArmWrestlingWithChasNDave

please, just stop! It’s Mumsnet! I’m not berating anyone, I called her/him narrow minded. OP has been told far worse off @Quincythequince, not much empathy by them to think they’re Doctor, if they are of course. I’m sure there was even a remark about another poster being asked if they were the OP’s minder, not very mature of the Doctor is it?

No I didn’t.
I asked her where she had read what she was asserting.

Turns out she had left a big chunk out, - this was pointed out by another poster (not me).

It’s amazing what falsehoods you can get people to believe when you leave out large chunks of text from the original written piece.

@Quincythequince

Go and tell your mechanic or builder exactly what should be done for a job you’ve given them and see what they have to say about it.

Why would anyone do that? As I previously said to you, OP never mentioned that they were telling or wanted to tell the GP how to do their job. You seem to be clutching on to something that just wasn’t even there to begin with.

GPs are meant to be lenient when prescribing antibiotics!

That sounds like telling someone how they should conduct themselves professionally.

Additionally, the OP also said she worked in some kind of healthcare capacity (these are my words not hers, but she intimated she had medical insight).

Very quiet when questioned exactly what it is she does!

Hmmm…

You can keep posting at me, I will come back to this it each time (although I am off out now). I am certainly not going to be beaten down by a bunch of people on MN in their foot stomping ‘mother knows best’ stance.

I have been professional and polite, if a little exasperated by certain aspects of various posts. That’s allowed you know.

See, this is exactly what I mean. You didn’t even acknowledge that she was not mistaken in having seen guidance and news reports about a change to prescribing antibiotics. She is a lay person, you are a doctor. Rather than accuse her of deliberately leaving things out to make a point (when she was actually asking for advice), the empathetic approach would have been to say “OK, I’ve looked at what you’ve read and the thing is that this bit here is important”.

@Quincythequince

I’m sorry but I took the time out to read all the posts OP had said, and in no way did they suggest they had medical insight. They told another poster that they had tested for covid as they had tests at home due to working in healthcare. You seem to be making a lot of incorrect statements.. and I’m sorry, you have not been polite and professional IMO.