It's a common complaint to hear. 'I went to my GP with this terrible cough and he said it was a virus.' with an aggrieved look to suggest that the person has been terribly deprived. As a GP, one of the things that used to really bug me was the hurt, shocked look we would get if we disappointed someone's expectations that they would be walking away with a treatment for their winter cold.I used to wonder why people were so unhappy. Surely they realised that we recommend the safest, best option? Why did they always look as though they thought we had a secret, hidden cure for a common cold and were depriving them of it?
So here's a tongue-in-cheek response to those complaining with 6 reasons we don't prescribe antibiotics.
1. The doctor wants you to suffer.
Clearly you must have annoyed the doctor in a previous appointment. Maybe someone has been complaining about you to the doctor and they're seeing a chance of a little revenge, or perhaps you offended the receptionist in some way and they secretly messaged the doctor to tell them you deserve to suffer. Actually, if we really disliked you a combination of erythromycin (an antibiotic highly likely to cause nausea and vomiting) and metronidazole (this is the one you really can't drink alcohol with-trust me you'd regret it) would be much more vicious than making you let the illness cure itself.
2. They're just trying to save money.
The news is full of the effects of the governments 22 billion 'efficiency savings' (don't let me go there, you may witness a hulk-esque transformation into a ranting, foaming anti-politician fanatic) so it stands to reason that the government are sending secret missives to GPs, probably bribing them with more time on the golf course, to reduce antibiotic prescribing.
Nope sorry. Amoxicillin costs the NHS about a pound. If you're paying prescription fees of £8.20 that's not a bad profit for the government, maybe they should be encouraging us?
We do get monitored on our antibiotic prescribing rates, although there is no financial incentive. High rates of prescribing can indicate a problem GP, which leads me onto the next item.
3. They just want to get rid of me.
'I went to the doctor and they just weren't interested, they just wanted me out of the door.' Now I'll be entirely honest here and let you into a major secret. GPs are human beings too. Sometimes, just sometimes we have days where we cannot wait to get home. Most of us have families and we might have been up all night with a vomiting toddler, we might have teenagers or spouses who have started the day with an argument and we want to home and make it right, or we might have spent all morning with a dying patient and just want to go home to a cup of tea and a hug from our nearest and dearest. We all try to avoid seeming rushed or disinterested, but we might just have a bad day where this shines through. I'm sorry this can happen, and always try to look back through notes if I feel I've had an off day and make sure nobody could have been poorly treated. This is why I cannot emphasize enough that you can come back and see us again, or see a different GP.
But enough of this tangent. Explaining why antibiotics aren't a good idea, explaining what symptoms to look out for, and when to come back if things aren't better, takes time and patience. I can print off and sign an antibiotic prescription in 30 seconds and be merrily waving you out of the door much faster, which is why high rates of prescribing can be a sign of a lazy or struggling doctor.
4. They're in collusion with 'Big Pharma' to rip us off.
I have heard this theory so included it here, but the only thing I can write about it is 'How?' How exactly would NOT giving antibiotics benefit the pharmaceutical company?
The recent government decided that GPs were a corrupt lot and easily influenced by drug companies. We are no longer even allowed to be given a free pen or Post-It note in case it makes us prescribe costly, unneeded medication. I have no objection to this and am a big fan of the No Free Lunch organisation but would just like to see the politicians apply such scrupulous measures to themselves.
5. They just don't care.
Once upon a time people applied to medical school because it was a well paid career or they wanted power and influence. Those people now go into finance or politics. There is no power and little money in being a GP.
The commonest reason people go into medicine is because they are bright individuals with good skills in science-based subjects who want to use their abilities to help people.
We don't prescribe antibiotics because we want to help. Take a winter cough, only 1 in 40 people with a winter cough go on to develop a chest infection needing antibiotics. Could we treat all 40 to prevent 1? Well it would be cheap, but antibiotics have a 1 in 8 chance of causing side effects. The maths is simple and doesn't even begin to consider the risks of antibiotic resistance. So although it might seem like we're being cruel and letting you suffer, we're really trying to prevent more suffering than is needed.
6. I want to make sure I'm not ill over Christmas/my holiday/my wedding but my doctor doesn't think it's important.
Okay this doesn't quite fit in but I included it as it is a common thing that people come to the GP with. The scenario is that they're feeling a bit ropey and have something important coming up and want antibiotics to prevent an illness.
Now I do sympathise with this. No-one wants their special day ruined so I can see why you come but...
Sadly we don't study Divination at medical school. Which is a shame. Being a GP would be so much easier if we could see the future. So I simply refer you to the statistics above. Ask anyone who's had antibiotic induced diarrhoea, C. Diff, Stevens Johnson syndrome or horrendous thrush from antibiotics and you would understand why we don't want to risk giving you this.
So next time you see your GP and they're not handing out the goodies, remember we really do have your best interests at heart.
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