In message <[log in to unmask]>, Paul Caldwell
<[log in to unmask]> writes
>What does anyone think of this?
>On Friday I saw a lady who had a simple sore throat, took a T/S, gave usual
>advice re PCM etc and off she went. Monday am she was first patient v. angry
>"you ruined my week-end, I had the doctor out on Friday night only 8 hrs after
>seeing you, he said it was definitelya bacterial tonsillitis, gave me
>penicillin and within 8 hours I was feeling better". Unfortunately the doctor
>was in the SE and I can't get hold of him. The T/S came back positive for
>strep. I am v unimpressed by the use of antibios in preventing sore throats
>going on to tonsillitis- the diagnosis sounds v dubious in this case anyway-
>or of their use in tonsillitis, although do give them for tonsillitis. I don't
>have a crystal ball!! Despite my explanations, said lady has sent in a
>complaint to my senior partner who always gives antibios for sorethroats. I am
>most pissed off. What would you have done?
In a way one could say your mistake was to do the throat swab in the
first place - if you hadn't you could have pointed out to the lady that
her sore throat could not possibly have improved within 8 hours of
starting penicillin if it was bacterial! I seem to remember reading not
long ago that oral antibiotics were no more effective than placebo in
clearing up sore throats with a a positive culture for group A strep
(I'm too knackered at the moment to look up the reference so you'll have
to take my word for it).
I recently had a lady in with a sore throat who was concerned *not* to
take an antibiotic. I did a throat swab and it came back positive for
group A haemolytic strep. When I rang her to tell her I'd printed out a
prescription for penicillin v ahe said "oh it doesn't matter - my
throat's better now"!
Toby
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Toby Lipman, 7 Collingwood Terrace, Newcastle upon Tyne
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