Should’ve been given antibiotics?

[ineedasleep]

Feeling weak and sorry for myself so be gentle. Warning description of sickness bug below.

I’ve been unwell for nearly 3 weeks. Chesty cough with delightful mucus, swollen and sore throat which is making me choke on my own salvia. Difficulty breathing at night and just unbelievable unwell and in pain. Throwing up due to cough. My body feels like it’s got the flu. I thought it was Bronchitis for 2 weeks and now I think I’ve got Strep throat. (I haven’t been this sick since I had COVID years ago).

Anyway, not to be a fickin martyr but I don’t ever go to the doctors for myself or to get antibiotics as I usually just think ‘I’ll get over this myself’ and I usually do get better but week 3 and I’m not getting better, probably getting worse.

My doctors have changed their appointment system last week and now do a triage with a phone call or seeing a paramedic. So anyway, I call up this morning, get told of the new system and they helped me fill out a triage form and that I’d be contacted by the end of the day. Luckily (or so I thought) I was told to come down to the surgery and see the paramedic this morning.

I haven’t got a car at the moment and so had to get myself and 3 year old in a cab to get to the doctors in time.

The paramedic gave me an examination, told me she could see I was very unwell, I had ‘crackaling’ in my lungs, my throat was very red but not swollen. Though she noted I had mucus she said she couldn’t do anything for me and wouldn’t give me antibiotics.

My face must have been one of disbelief because I was having coughing fits in front of her, gasping for breath and I have no voice left.

She said ‘if at any point you can’t swallow your own salvia or finding it difficult to breathe call 111’. I said ‘but I am finding it difficult to breathe and I can’t swallow my own salvia; I keep drooling’ (which I had told her earlier on in the examination). And she said ‘ok, well when that next happens you’re going to have to go to A&E and get seen by them and get antibiotics there’.

I was so sad. I just explained to her that I have no car, I’m a single parent and I can’t go to the a&e 10 miles away as the wait time is around 8 hours. I have no one who can help to watch my son so that option isn’t feasible considering I thought going to the doctors for antibiotics was the right route, not a&e.

She just gave a sympathetic smile and said there’s nothing she could do.

After trudging back home on the bus, feeling like I’m about to faint and having a forced afternoon nap with my son I’ve woken up like….I really should have antibiotics shouldn’t I? Or am I being dramatic?!

I think "guessing" is a bit of a disservice to the HCPs out there and what they're actually doing.

The huge majority of patients attending with these symptoms do get better themselves without antibiotics. It's not just 'guessing' its years of training and experience pulling together many factors in decision making to form a diagnosis and treatment plan based on available evidence. You don't have to be on deaths door to be prescribed antibiotics, your just have to have a history/examination that suggests they're needed to get better.

Bringing in finger tip blood tests could be useful in this scenario but doling out antibiotics to everyone on the off chance that they have a bacterial infection is going to cause more harm than good. Don't forget that even if infections are bacterial most people can fight them off. It sounds as if you were clinically assessed and at that time the balance of probability was that you had a viral illness . The paramedic advised you as to what to do if things got worse quite rightly. If things are worse there is nothing wrong with contacting the surgery again today.i do feel for you, I had something similar in December and have never felt so ill.

@SleepyRich you are right. But from experience... that doesn't happen.

I was pregnant with a sinus infection back in 2017. They refused to give me anything and told.me.to take sudafed. I was going into week 7 and felt like I was losing my mind. I had to get really angry before getting the antibiotics which cleared it up and i felt much better after 3 days.

A lot of appointments where I am are on a telephone call as you can't get a fave to face so, yes when it comes to infections. They do guess and prefer to wait until you are really ill.

There are some really good GPs out there, but lots who aren't too.

Have you been seen by a doctor OP?
You do sound like you are really ill.
High temperature, problems breathing, problems swallowing, noise in lungs.

This is serious enough to go to A&E.
Whatever is wrong with GPs these days!

Agree.

@ineedasleep Are you taking your temperature very regularly? If your fever is spiking and dropping it could explain the two readings and would be a sign generally of bacterial infection. It sounds excessive but taking it every fifteen minutes for a couple of hours and recording it will show you if it is spiking and dropping. I believe it’s less common in adults, but worth looking for if you’re this ill and getting low readings like 37.8. If you do find you have one, take the readings to the GP with you to show them.

Are you ok OP?

@ineedasleep are you ok? Have youbeen properly seen and are you getting better?

• I think "guessing" is a bit of a disservice to the HCPs out there and what they're actually doing.

The huge majority of patients attending with these symptoms do get better themselves without antibiotics. It's not just 'guessing' its years of training and experience pulling together many factors in decision making to form a diagnosis and treatment plan based on available evidence. You don't have to be on deaths door to be prescribed antibiotics, your just have to have a history/examination that suggests they're needed to get better.*

Possibly giving the paramedic a bit much credit there. They're not doctors, they're not trained diagnosticians, they really shouldn't be seeing undifferentiated patients without discussing with a doctor.

How does paramedic experience equip you in any way to diagnose and manage an acute chest infection?!

The mission creep of allied health professionals is dangerous 🤦🏻

I've had tonsillitis in the past where I couldn't swallow.. twice actually and the doctor wouldn't prescribe anything. Did an online doctor consultation and got amoxicillin the next day, immediate improvement! I just do that these, which is ridiculous and costs about 40 quid, but I refuse to sit and feel like shit if I know I need them x

Update:

Thank you everyone for your messages and concerns I’m going through them all now. I’ll be honest I took a horrific turn and felt like I was unable to breathe the other day and have only picked up my phone today feeling slightly more human.

I somehow, got through to Wednesday morning (doctors were randomly shut on Tuesday 🙄) and made an emergency appointment with them.

I asked for a phone call as I couldn’t move and the idea of carting me and my 3 year old in a cab back down there yet again this week filled me with dread. However, the very unhelpful staff told me I HAD to come and see them and if I didn’t I needed to call an ambulance and go to A&E (my doctors have always been amazing but this fixation on a&e was baffling to me, I know I was very unwell but I explained my situation and told them I just wanted/needed antibiotics).

Anyway, I dragged my sorry self down there to only sit in the waiting room looking like a cast member of the walking dead, with everyone staring at me hacking and unable to catch my breathe for an hour and a half over my appointment time. I wanted to curl up on the floor.

I finally got to see the doctor who did a terrible job at checking me over (listened to my ‘chest’ once on my collar bone and told me my chest was clear 🧐) took my temp on my ear lobe and said my temp was fine (I took it once at home and was 39 still) looked at my tonsils and said they weren’t swollen, which I know; it’s my throat that’s swollen, she even said ‘look at your sons tonsils there way bigger than yours (side note; we’ve already had this looked into and my son just has ridiculously large tonsils so to compare us felt odd?)

She then finally checked my neck and said ‘oh my, your neck is so swollen’ DUHHHH I KNOW.

However, she was still saying she couldn’t give me antibiotics 🫠 I just said I need them now I cannot continue without them; look at my records I haven’t had any in 4 years, I know my body, I need them.

She then said (like many others said they had been through) she’d send off a test to see if it’s viral or bacterial, when asked how long that would take she said 10 days. My face must have said a thousand words because she then said ‘oh but we can’t really wait that long really, ok I’ll prescribe you something’ and so I now have two weeks of clarithromycin and an inhaler and wow, the inhaler, what a game changer. I couldn’t even give a ‘good sample’ because (tmi) I was throwing up from choking on my own salvia. My air way still felt blocked last night but this morning I’m breathing normally again, albeit exhausted.

Thank you all again for checking in on me and sharing your experiences. I can’t believe the difference the inhaler has made. I genuinely can’t believe they sent me on my way the other day without a thing.

Really glad you got some help.

Two thirds of antibiotic use worldwide is in livestock, you'd have been treated better if you identified as a dairy cow.

Where is the three year olds dad and why isn't he helping right now?

Can you order rapid test for strep A online or purchase in Tesco ( that’s where I go mine).

Glad you’ve seen a doctor ! Fingers crossed you start to feel better.

Glad that you are feeling better.

Your GP is utterly useless. Did she really compare a child's tonsils to an adult's? And it took her a few statements to realise your throat was swollen?

I hope you fully recover soon.

So glad you finally got something and some relief!

Hope you feel much better, much quicker!

Definitely on your side with paramedics clearly not being equivilent of Drs, but seeing undifferentiated patients without the oversight of a Dr is routine paramedic work, its not 'mission creep'. Its the job from day 1, all thats changed over the past few years is rather than targeting us at the frail multimorbid patient that cant goto the surgery someone has worked out that we can see 2-3 times more patients in a shift from a gp surgery than on the road. Over 30% of 999 calls are discharged by standard frontline paramedics at scene, with specialists discharging around 70-80%, although thats more targeted triage, but these are all patients either self declaring emergency, or being triage as emergencies.

Obviously there's complexity behind the reasons for this, how right or wrong it is and absolutely there are valid arguments on both sides. My point is just that it's wrong to describe this a mission creep. Most acute sore throat/cough presentations should be managed by the patient reading through the nhs website with the red flags etc, I don't believe we should be advising that every cough/sore throat needs GP oversight!

The training of paramedics certainly covers consultation and assessment of suspected chest or URTI. Most trusts now have staff issuing abx from pgds or their staff are qualified prescribers. But as you'll be aware the majority just need time to resolve and mostly screening for the atypical/suggestive of something systemic occuring.

This is routine paramedic work, in addition walk in/urgent care centers are typically nursing led and have been around for a long time now so it's nothing new. I think this is a very different position to that of the PA role and grouping it allthogether dilutes the very valid concerns about this new role.

That being said if there was a funding model to provide sufficient qualified GPs instead of all the ACPs/nurse practitioners/paramedics I'd absolutely vote for it, but realistically this model is never going to occur in a manner that meets the ever increasing demand of the public. The majority of acute urgent presentations can be safely managed by ahp, whether that's treating/discharging or escalating when uncertain/atypical presentation, so GPs can focus on complex, chronic, high risk etc that's more benefiting of their increased skill.

I have been ill over the end of last week and weekend. Started with a bit of a sore throat and by thursday I had inflamed tonsils with bisible pus spots. I had no fever, so I thought it would go on its own. But I was still the same Saturday. A nurse triaged me on the phone, she booked me in for appointment and a nurse saw me, just a few hours later, and she gave me a heavy course of antibiotics. That was 111.
Why can all GPs do the same? That is my question really. I have been fobbed off by receptionists, taken the piss out by receptionists (as they thought the issue presented to them was mot "serious" enough or something like this) and it has taken 3 months for me to get an appointment with the GP, after explaining the issue to them for the triage and going back twice to ask when will they give me an appointment. Why are they allowed to do this?
From my point of view, where I live, NHS works perfectly (old buildings, 12 hour shifts and issues like this, but really good patient care) and GPs are close to useless. I think GP practices should be part of the NHS and eliminate this ridiculous non-appointment system that they have currently.
We will have elections soon and I think we should be joining together to put forward these issues. That people need their GPs for regular appointments, to monitor conditions, treat temporary issues and prevent escalation of issues. Not to be there to take hours to answer the phone and to drain the energy out of patients.

By the way, best GP appointment we ever had were with their nurses.
When I say GPs should see their patients, I mean whoever they assess is needed for their symptoms. But ours, if they find something worrisome, they call in the GP to see you, not have a guess work and send you back home...

And OP, how are you doing? Are you feeling better?