Why have we not got the message out there about antibiotics?
How come we struggle to get parents to give their kids life-saving vaccines, but we've convinced them to to demand an antibiotic for their little ones, at the first sign of a sniffle.
I saw a 5 year old boy, Thomas, a few days ago in the emergency department. Thomas had a mildly elevated temperature, a runny nose, a sore throat, and a pain in the side of his head.
"We're here because we can't trust our GP any more".
"Really? And why is that?".
"He told us Thomas IS sick, but he won't give us an antibiotic", mum answered.
As Thomas sat there on the trolley-bed watching his portable DVD player, and laughing loudly at the cartoon on his screen, I began to suspect that A) He did not have a bacterial infection and B) This consultation was not going to end well.
I gave him a good look over, and concluded that he had an improving, self-limiting viral infection. Red ear, red throat, runny nose and a bit of a temperature. He was eating and drinking normally again, and seemed to be on the road to recovery.
I sat down with Thomas' parents, and explained the difference between viral and bacterial infections. I told them that this infection seemed viral to me, and reassured them that their GP had made the right decision.
"Look, can we stop all the side stepping here? Are you telling us he's not going to get an antibiotic?".
"I'm sorry. I'm not going to prescribe an antibiotic because....."
"OK, can we get a second opinion. He gets these infections several times a year, and ALWAYS needs an antibiotic".
I told them I'd happily get the consultant involved, but that this would take some time.
They agreed to wait, and Thomas loaded another DVD to watch. After about 20 minutes they started to complain loudly to each other, as people do when they're trying to get your attention.
"I told you we should have brought him to the other hospital", dad said to mum, VERY loudly. "At least THEY know what they're doing". This went on and on, and I ignored them.
20 minutes later, they got up to leave. On the way out, they told random nurses and patients int he corridoor that they were going to find a private doctor "Who bloody knows what he's doing".
The thing is, I suspect they may have.
These parents are very likely to have found a doctor who agreed to give Thomas some Amoxicillin. Then Thomas will have continued to get better, except for his antibiotic-induced upset tummy. In two more days he'll be right as rain, and they'll tell all their friends that the antibiotics cured them, and that the pillock paediatricians at the local hospital haven't a CLUE what they're doing.
It has bewildered me for so long that we give out so many antibiotics without any justification. It's hard not to, and when I was a bit more junior I did so, when I couldn't stomach the fight. I don#'t resent the doctors who prescribe them easily. But I really wish they wouldn't.
Anyone got any thoughts on what percentage of antibiotics given for acute respiratory illness actually result in improvement? I've no idea, but I'm sure it's very low.