Further Confessions of a GP

Having said all this, you may be surprised to hear that GPs still prescribe far too many of them when not necessary. ‘Why?’ I hear you shout. Basically it is because many patients still expect and demand them and at times it can be really difficult to say no. Some patients feel cheated, wronged and angry if they leave the surgery without them. They storm out, slam the door and go to A&E, where they lengthen the waiting times and eventually get the antibiotics they want from the exhausted, broken A&E doctor who is so worried about breaching the four-hour wait targets that he doesn’t have the energy to say no.

Here is an example:

Me: ‘Good afternoon Mr Jones. How can I help today?’

Patient: ‘I’ve got a sore throat, a dry cough and a blocked nose.’

Me: ‘Hmm, well after listening to your chest and looking at your throat and ears it would appear that you have a nasty viral upper respiratory tract infection also known as a cold.’

Patient: ‘Thought as much, Doc. If I can just have a course of antibiotics, I’ll be out of your hair. I can see how busy you are today.’

Me: ‘Actually, Mr Jones, I don’t think antibiotics will help because it’s a virus you’ve got and antibiotics don’t work against viruses.’

Patient: ‘But I’m off to Tenerife on Thursday and I need to be better for that.’

Me: ‘I do sympathise, Mr Jones, but the antibiotics don’t work against viruses regardless of whether you are off on holiday or not.’

Patient: ‘I see, so my taxes pay your salary, but you’re too tight to fork out for a few lousy antibiotics.’

Me: ‘It really isn’t about money, Mr Jones, it’s about what will and won’t make you better.’

Patient: ‘I’ve been getting antibiotics for my colds for years and I always got better. Why did those other doctors give me antibiotics?’

Me: ‘Perhaps they were giving you what they thought you wanted. They were succumbing to your expectations and choosing the easy option. We all want our patients to like us and as a result doctors are guilty of having overprescribed antibiotics for years. I apologise for that. It is something that this current generation of GPs are trying to rectify by changing expectations and educating…’

Patient: ‘Well I think it’s you that needs the educating ’cos you’re a shit doctor and I’m off to A&E if I can’t get my antibiotics from you.’ [Loud slam and no Christmas card.]

If I had simply prescribed the antibiotics, Mr Jones would have left happy. I would have avoided the long stressful argument that made me run even later in my busy afternoon surgery. The cost of the antibiotics would have been a drop in the ocean compared to my overall drug budget, and in the growing worldwide crisis of antibiotic resistance, one more course of amoxicillin probably wouldn’t have made a huge difference. Mr Jones would have given me positive feedback in my patient satisfaction questionnaire and this would have made me look like a ‘good doctor’. Nevertheless, I was a better doctor for saying no.

Diabetes

Type 2 diabetes is a disease that GPs are seeing more and more of, and recent research suggests that treatment will use £16.9 billion of the NHS budget, as the number of diabetics rises from 3.8 million to 6.25 million by 2035. This has fuelled scaremongering in the media, with talk of ‘diabetes bankrupting the NHS within a generation’.