Written Paper - October 2006
Examiners' Comments
Question 10
Why was this question asked?
Respiratory infections make up a large part of
a GPs workload. There is an increasing concern about antibiotic
resistance as well as the potential side-effects with the
widespread use of antibiotics. Recent evidence suggests that the
risks of antibiotics in uncomplicated upper respiratory tract
infections outweigh the benefits.
The partnership dynamics are changed when a
new partner joins. If the new partner makes dogmatic and
challenging statements life can be interesting!
What were the themes of the
question?
The themes were the issues that this statement
raised. There is a lot of evidence about the prescription of
antibiotics in general practice. GPs have to do their best for each
individual patient, they need to be flexible, considering the
patient’s needs. One can only be sure that an infection is
’uncomplicated’ when it has resolved!
Why is the new doctor making such statements?
Has she had a bad experience with the prescription of antibiotics?
Does she have an attitude problem, or is she unhappy? Why is she so
rigid? Is she trying to make her mark within the practice? Perhaps
to let them know how she means to continue.
The patients may also be taken aback with such
a rapid change of policy. If partners differ, there is the scope
for one doctor to be played off, one against the other.
There are also huge issues for the other
partners who may have an increased workload as patients cope with a
rapid change of policy. GPs are not the only people who prescribe
for patients. Nurse prescribers, A&E doctors & OOH doctors
can all prescribe antibiotics.
How well was this question
answered?
The performance overall was disappointing.
Most candidates were aware of the issues for the existing doctors,
their team, and patients but less aware of the issues for the new
doctor. There was little mention of the evidence for antibiotic use
in upper respiratory tract infections. Several candidates answered
the question by using an ethical framework, without considering the
other issues. This did not work well in this particular
question.
Further reading
Sign guidelines- no 34 Antibiotics in sore
throat
http://www.sign.ac.uk/
BMJ, doi:10.1136/bmj.38891.681215.AE
(published 21 July 2006)
Are antibiotics effective for acute purulent rhinitis?
Systematic review and meta-analysis of placebo controlled
randomised trials
BMJ 2005;331:301-302 (6 August),
doi:10.1136/bmj.331.7512.301
Delayed prescribing of antibiotics for upper respiratory tract
infection BMJ 2004; 329: 431
Ineke Welschen, Marijke M Kuyvenhoven, Arno W Hoes, and Theo J M
Vertract
Effectiveness of a multiple intervention to reduce antibiotic
prescribing for respiratory tract symptoms in primary care:
randomised controlled trial BMJ;1999,318:715-716 9 13 march)
An evidence based approach to reducing antibiotic use in
children with acute otitis media: controlled before and after study
Christopher Cates, general practitioner.
Manor View Practice, Bushey Health Centre, Bushey, Hertfordshire
WD2 2NN
BMJ 2006;333:311-312 (12 August),
doi:10.1136/bmj.333.7563.311
Antibiotics for urti & conjunctivitis