on 12/13/01 4:52 PM, chris markwick at [log in to unmask] wrote:
> Quick straw poll amongst cas officer last night revealed all would prescribe
> amoxicillin for otitis media. (including VTS SHO)
> It makes things difficult for us GPs if we not all preaching same messages,
> but then if A&E is a second opinion is it appropriate?
I wonder if the increased 'second opinion' factor amongst patients wary of
medical incompetence is one of the reasons for rising attendance (has anyone
audited this?).
Certainly, patients who come in looking for a specific treatment 'because it
worked last time' etc., are the hardest to deal with in primary care and
common sense would suggest they are the most likely to seek that treatment
elsewhere.
Of course, when they finally get their amox and then get better - by
themselves, perhaps one day earlier than they would have otherwise - they
give the amox the credit and the cycle continues.
If you can convince the patient to give you more time ("It's not as serious
as last time yet", "no lymph nodes yet", "no pus present yet" etc..) but
promise them antibiotics in the next couple of days if they do not get
better, then once they have goten better by themselves they are more likely
to believe you next time. (If you can get past the "I want an antibiotic so
it does not get to that stage" defence).
Of course A+E patients who go for a second opinion are a different patient
population to those who do not. It may be they are more ill, or it may be
that they are more demanding, or perhaps both.
Giving them what they want gets rid of them so much faster and reduces
complaints - but it is not necessarily good medicine and leads to increased
future attendance.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
CONFIDENTIALITY NOTICE
This document may contain confidential information belonging to the sender
which is protected by the physician-patient privilege and should only be
read by those persons to whom it is addressed. If you have received this
e-mail in error, please notify the author. Please also destroy and delete
the message from your computer. Any form of unauthorised reproduction,
dissemination, copying, disclosure, modification, distribution and/or
publication of this e-mail message is strictly prohibited.
|