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Antibiotic Awareness Week: What’s your spiel?

Welcome back!  It is ANTIBIOTIC AWARENESS WEEK here in Australia.

The slogan I have been pushing with my trainees is: “Take time to have the chat, Don’t just write the script.”

Of course, that “chat” can turn nasty!  We have trained generations of families to expect, crave and depend upon the magical pills to cure every cough, sneeze and fever…. but we know that it is largely snake oil!  So my challenge to you all is to share your best spiel.  What do you say to the eager parent who really, really wants a bottle of Amoxil for that slight red ear?  How do you rationalise the need for a penicillin suspension for a runny nose with your next man-flu?

So I have a challenge for you all…

 

Send me your favourite lines.  The throw away comments and phrases you use to talk em outta the pills.

You can comment below if you like – or better still send me an audio recording of your favourite spiel – just talk it into your phone and send it over to broomedocs@gmail.com

You might wing a prize.  But better still you might allow the rest of us to share your wisdom with our patients and keep the lid on the Antibiotic Armageddon that may be not too far away!

GO on!

Hit me with your best lines.

Casey

Comments

  1. So may difficulties when the medical profession starts abandoning patients in favour of consumers. The notion of catering to ‘wants’ not ‘needs’ creeps in…as well as the fear of litigation for the missed but extremely rare case. Hence the descent into giving antibiotics ‘just in case’ both in GP clinic and in theatre or the wards.

    Of course its not just antibiotic stewardship. The medical professional has to be able to say ‘no’ to many inappropriate tests -- the CT for low back pain, the CA-125 for bloating and fear of ovarian carcinoma. The murky area of prostate screening….and so on

    As always, Inframe these in evidence-based manner, often wrapped up in a story (the tale of american airforce bases and Strep throat is an example)…..then frame it in terms of risk of harm (what I would want for my loved one(s))….then if all else fails, the immortal line from an ICU consultant

    “Patient X family want VA-ECMO for their nonageneratin, demented, doubky incontinent grandma with cardioresp failure. Thats nice. I want a pony for Xmas…but I’m not going to get one”

    Not something I would condone, of course.

    • Will Horwood says:

      Great post as usual Casey.

      I usually try and explain the difference between a viral and a bacterial infection, and to reassure those who think it must need something because it’s so bloody awful, I use the example of influenza as horrible viral infection with no cure.

      I also tell the patient they’re more likely to get an upset tummy, diarrhoea (and/or thrush for women) than a significant improvement in their symptoms. And then I tell them that for an otherwise healthy person, even if it is a mild bacterial infection, it can often get better on it’s own with only a slight delay (1-2 days) in clinical improvement. Seems to work most of the time.

      My question is -- how does everyone else go with the statistic of increased antibiotic prescribing as each consulting session progresses?

  2. Roy Finnigan says:

    Nice to hear these sentiments Casey, don’t know if you have watched the NPS tropfest videos promoting antibiotic prescribing restraint but worth a look.
    Of course it would be nice if more of our north west patients would take their antibiotics as prescribed for their serious skin infections etc! Topic for another day? -- improving concordance…

  3. I’m passionate about this. I tell people “all the big studies show that you’re gonna get better from your sore throat/sore ear/flu regardless of whether you get antibiotics or not but if you do have them you might get one of these super-resistant bugs we keep hearing about on the news. If you then get sick with one of those at a later time, it could be really hard to treat and it might even kill you! So it’s best to save antibiotics for when you really need them.” Patients usually accept this pretty well.

  4. Victoria Brazil says:

    Of course see a few of these in ED, although i think we’re mostly luckier than in general practice wrt patient expectations. Also see a few ‘I’ve been on antibiotics for a week from my GP and i’m not better I need stronger ones..” 🙂

    My ‘lines’…… (and not pretending they always work!)

    “You’re lucky -- this is the kind of thing that gets better on its own”

    “You’ve been doing all the right things. Keep it up”

    “We can help you feel a but better with things like panadol to help the symptoms, and we’re going to do the best we can there. Unfortunately the only cure for the infection itself is time”

  5. James Walker says:

    I try to frame it from the natural medicine / lifestyle medicine point of view. I tell my patients that giving antibiotics for a cold is just the drug companies trying to get money out of sick people because all the studies show that these expensive antibiotics aren’t necessary. I have a list of over the counter remedies for a sore throat (paracetamol/ analgesic throat spray) and encourage them to use natural therapies such as rest (with lots of DVDs and ice cream), icy cold drinks, and fresh fruit juices. I also find this a good opportunity to address their smoking, explaining that if you smoke, then you’ll probably get more colds that last longer and will be harder to get over. (I do not support natural therapy that isn’t evidence based). I also explain that by allowing the body to fight the virus, we are helping to build the immune system. And if they want to avoid future colds, look at the flu vaccine, increasing fruit and veg in their diet, better sleep hygiene and stress/ alcohol management.

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