Columnist Dr David Turner says NICE should put its own guidelines to the test in the real world
Dear NICE,
Thank you for your recent draft guideline that proposes GPs should not prescribe antibiotics for suspected acute respiratory infection (ARI) based on remote consultation only.
I am sure that you have tested the draft guideline yourself in real-life general practice because, of course, you would not possibly be recommending we adopt a practice you have not personally used extensively.
With this assumption in mind, and perhaps it is me being a bit dim here, but could you explain to me exactly how I would utilise your new guidance to best effect in my practice population, which is rather top heavy in very elderly, hard-of-hearing patients living alone?
For illustration, below is an example of a typical phone consultation with an older patient who has respiratory symptoms.
‘Hello, this is Dr T. Am I speaking to Mr S?’
‘WHAT?’
‘I AM DR T, COULD YOU CONFIRM YOU ARE MR S?’
‘Mr S, YES, that’s me.’
‘How can I help you?’
‘I’m all chesty, doctor.’
‘How long have you been “chesty” for?‘
‘Oh, some time.’
‘Could you give me an idea how long?‘
‘Oh, quite a while.’
‘ARE YOU SHORT OF BREATH?’
‘SHORT OF WHAT?’
‘BREATH!’
‘BREATH, yes, always.’
‘Do you have anyone there who can check your pulse and breathing rate?’
‘Me, what? I live on my own.’
‘I think we need to see you at the surgery, can you come down now?’
‘No, I don’t have any transport and none of my family live nearby.’
‘How about a taxi?’
‘A TAXI? I can’t afford that.’
In the above scenario that features an isolated elderly patient who has chronic respiratory and multiple other health problems, and in the absence of resources to undertake a home visit, could you suggest an alternative to antibiotic prescribing on the phone?
I look forward to your response and I will be sure to pass any of your advice on to all my older, housebound, hard-of-hearing and socially isolated patients.
Best wishes,
A GP living in the real world
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here
Don’t those patients have a monthly repeat of alternating antibiotics as ‘rescue packs’ as instructed by the Respiratory Specialist Clinician?
Well said david
‘Absence of resources to undertake a home visit?’
Poor excuse, try that in front of FTP panel!
Home visit. Otherwise you are negligent.
Erm i dont think so. How negligent? How accurate is a clinical exam in diagnosis a chest infection?
Someones been hiding behind a lanyard too long