So GPs are once again to blame for encouraging the spread of antibiotic resistant bacteria which will eventually annihilate all mankind. Well- mea culpa. However before you tar and feather me let me take you through a typical GP consultation and then you can draw your own conclusions.
"Come in"
"Oh hello Doctor. I thought I was seeing Dr Oldschool"
"Sorry - I'm afraid Dr Oldschool is away. I'm Dr Saintly. How can I help you?"
"Well, it's little Leah. I think she's got an ear infection. She's had it before."
I shall omit the details of the next four minutes during which I take further details of the episode of illness and examine an outwardly robust looking 4 year old finding nothing untoward apart from a slightly raised temperature on the way.
"Thank you Leah. You are a good little girl. Well, Mrs. Angst, apart from a slight temperature I am glad to say that I can't find anything untoward with Leah."
"You don't think she needs some antibiotics then Doctor?"
"No. This is likely to be a viral infection which will get better on its own. "
"But the last time she had this she was really poorly until Dr Oldschool gave her some amoxicillin."
"Well I don't think there's any need for that now."
"But she starts school next week and I don't want her to miss the first day. She's really looking forward to it."
"Well, as I said, I really cannot see any way that antibiotics will help here and if we prescribe some now then we might be encouraging resistant bugs and then she won't be helped in the future if she does need them. I hope that makes sense."
"So you won't give her any now then?"
"I don't think that it is necessary and we are really being encouraged to cut down on prescribing."
"So what should I do about her temperature then?"
"Er nothing really. NICE, our bible for good medical practice, advises that nothing should be done about childhood temperatures."
"What about some paracetamol then?"
"Well, as I said, we advise nothing- only drink plenty."
"So you aren't going to give her anything then?"
Me- blank face.
"OK then. Whilst I'm here can you give me some antibiotics for my sinusitis? I know what it is. I have had it before. I have left it two weeks but it is no better and I know antibiotics always clear it."
"Sorry, I'm afraid the practice policy is one appointment/one problem."
"But I tried getting an appointment and there are none available for 3 weeks."
"Oh all right then" and sensing a need for some diplomatic flexibility here, "but I'm afraid I still can't give you any antibiotics for it. NICE, the people I mentioned earlier have told us that we should not treat sinusitis. It always gets better in three weeks. So you've only got a week to go."
"Oh for f**** sake. I'm going to come back to see a proper doctor." Storms out
Now do I get a warm feeling of self-righteousness after such a consultation? Is Mrs Angst grateful for being 'educated'? Do I sit back basking in the knowledge that I have been a good clinician? No I do not. I feel useless, angry, frustrated and generally upset. And in that receptive frame of mind I then call in the next patient.
Politicians and academics may wish to consider how they would handle the above, I repeat typical, scenario before lecturing GPs who may have to deal with such cases daily amongst at least fifty others.
