 |
 |
>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? A very common problem. And your lack of a crystal ball afflicts most honest practitioners. I tell patients that, at the time of the exam, I don't see any signs of a bacterial infection, but that doesn't mean that the situation wont change over the next 6-12 hours. I agree that treating to prevent a sore throat really help. I don't do it. I remember a study that compared experienced doctors "clinical impression" as to whether a sore throat was strep or not with the culture results. These doctors were right only 50% of the time - no better than flipping a coin! Lastly, I tell patients that antibiotics may have serious consequences. I mention the 42 year woman started on amoxicillin for an upper respiratory infection. Although she had no history of drug reactions, she had a respiratory arrest and died from an allergic reaction. Rich Sagall, M.D. +-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+ |Rich Sagall, MD ([log in to unmask]) | |Publisher of Interesting! and Pediatrics for Parents | |There's email versions of both publications. To subscribe email to | [log in to unmask] or [log in to unmask] with a message | |"subscribe" followed by your email address | +-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%