In a rather high risk (but successful) manouever, I once turned the same
situation to my advantage.

I offered the parent the BNF, and said, "you choose."

The effect was quite startling. He said, "but you're the doctor."

I replied, "quite, and my opinion is that antibiotics won't work here, and
might even be harmful. *You* take the risk."

After much blathering, my opponent retreated.

I then spent 48 hours fervently hoping that I was right!

The alternative (and safer) method, is to ask the patient if they are
threatening you. Curiously, this is usually quite effective. You win either
way. Most people will say no, because they don't want it made explicit (and
also because they can work out that you are up to something) - in this case,
you can then exploit into the gap and ask why on earth they were behaving
the way they did (I usually give them a let out of "of course, any parent
would be worried under the circumstances, but remember, you can bring the
child back any time etc). If they say yes, then you can occupy what moral
high ground is left , and say "fine, I am prescribing under duress here, and
I am going to make a statement to that effect in the notes before taking the
matter up with the CHC/HA/God etc."

Andrew
-----Original Message-----
From: C-P <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 08 February 1998 21:25
Subject: Lost the Battle


>Saturday morning surgery, first patient - apparently a pleasant enough dad
>with his 12 year old daughter. The daughter, a known asthmatic on MDI
>beclomethasone and salbutamol, has gone a bit wheezy; parents have,
>reasonably enough, increased steroids, and come for advice. Examination of
>the girl reveals no specific focus of infection, temp is normal, ENT - NAD,
>and chest has a few wheezes, but nothing spectacular. I explain all this to
>dad, agree the next step up the BTS guidelines, about to say cheerio,
when.....
>
>*BAM* - "So you're not going to give her antibiotics then?"
>
>Careful explanation of why I felt this was entirely inappropriate resulted
>in a verbal haranguing along the lines of "I KNOW that if she doesn't have
>antibiotics, she'll end up in hospital within the next few hours. You did
>this last time and look what happened; if she'd seen any other doctor,
she'd
>have been given antibiotics without any problem. If my daughter gets any
>worse, I'll take this a lot further, believe me."
>
>Attempts at any kind of logical explanation of best practice, my 15 years
>experience in general Practice, etc, merely served to inflame the
situation,
>and to avoid a potentially nasty confrontation, I gave in and gave him a
>scrip for antibiotics.
>
>I lost the battle with him, and I'm sure I've also lost the war - I can't
>see me getting anywhere with any attempts at patient education. So what do
I
>do? Give in each time, suggest they find another doctor, remove them from
>the list, or simply stand my ground and tough it out next time?
>
>Offers please,
>
>C-P
>***************************************************
>
>  Dr Adrian Canale-Parola
>
>"If you want a doctor I'll examine
>Every inch of you....."
>
>***************************************************
>
>




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