Do GPs Have Prescription Limit?

browser on 27/06/2023 - 20:40
Last edited 27/06/2023 - 20:44

My regular GP (General Practitioner) only works on certain days, so there's a backup clinic I go to at times of need. For some season a couple of GPs there refuse to give me the script (antibiotics such as amoxicillin) as requested on separate occasions, even when I have described the symptoms and explained it will get worse. They always brush it off by recommending over the counter alternatives.

It is really counter productivity, wasting my time seeing them in the first place, wasting money on ineffective medications, wasting more money to see another GP to get the script, while unnecessarily prolong the illness and discomfort.

What is it? Is there a quota on the scripts they cannot exceed? Or an indication they are less competent and unwilling to risk the wrong script? Or simply a business model to drive repeated visit?

Health & Beauty

Comments

        • Clear on 28/06/2023 - 08:58

          Yeah some people will easily get on the bandwagon here.

          Mentioning cold symptoms is one way to expose the lazy doctors. Some will just send you on their way without checking if it's something else, i.e. bacteria infection.

          • May4th on 28/06/2023 - 11:31
            +18

            @Clear: absolutely, much easier and financially rewarding to give a script for amoxicillin with a 3min consult with a happy customer, than spend 10-15min explaining why antibiotics are not the answer and potentially end up with a complaint with a patient like OP. and trust me the OP is not the type of patient a GP wants to keep coming back if you think that's why you are not given a script

        • Radiopej on 01/07/2023 - 10:57
          +1

          I'm reminded of this little gem.

          GILDEROY LOCKHART: Books can be misleading.
          HARRY POTTER: You wrote them!

  • [Deactivated] on 27/06/2023 - 23:11
    +9

    I think there is a prescription limit for people in relation to antibiotics - you can become resistant to them. In fact, you may as well be my aunt who only recently informed my Mum that she's suffering from yet another cold & whinged that her GP refuses to prescribe her any more antibiotics because she's taken too many courses within a given time frame.

  • freefall101 on 27/06/2023 - 23:16
    +10

    You should not be continuously getting infections with the knowledge it will get worse, sounds like you need a longer talk with a GP to figure out what's going on.

    • browser on 28/06/2023 - 00:18
      -5

      It's over a number of years, once or twice a year sorta thing, but frequently enough I can recognise if it's going to be a "lengthy battle" requiring antibiotics or a just a good night's rest. Obviously I'm not going to see a GP just because a cough in the morning, but over a few days and things start to get worse those are the signs.

      • nigel deborah on 29/06/2023 - 18:55
        +9

        Vitriol aside you really should investigate this further with a medical professional. If they really are bacterial infections, twice a year is NOT normal.

      • gengi on 30/06/2023 - 09:09

        If it is a regular thing they can test for bacteria and the sensitivity to antibiotics. eg do a sputum test or urine test. there is quite a lot of antibiotic resistance out there to amoxycylin.

        just giving you the easiest antibiotic and not following up is really poor medicine. Though it may be good customer service.

  • Pufff on 27/06/2023 - 23:17
    +14

    How and what are you constantly getting sick from that requires you to constantly get antibiotics?
    Makes no sense

    • bdl on 27/06/2023 - 23:56
      +2

      Ozbargain forums :)

    • browser on 28/06/2023 - 00:13

      Once or sometimes twice a year is hardly "constantly".

      • Pufff on 28/06/2023 - 07:26
        +22

        You're kidding once or twice a year is a lot.
        You need help with the persistent causes not antibiotics. Antibiotic resistant bacteria is a thing.

    • May4th on 28/06/2023 - 08:32
      +1

      How and what are you constantly getting sick from that requires you to constantly get antibiotics?
      Makes no sense

      chlamydia (an actual good reason to get antibiotics)

      • Pufff on 28/06/2023 - 17:10
        +1

        Lol well I didn't want to be so blunt

  • browser on 28/06/2023 - 02:02
    -7

    Interesting to hear about all the reasonings (some are reasonable). But end of the day if you are unwell for a few days and getting worse, take a sickie, but instead of resting, having to spend a better part of the morning to go see a GP, only to send home with ineffective medicine. Still sick in the afternoon and continue to deteriorate, then take a second sickie to see another GP, now twice the time twice the cost.

    How can you say the first GP has determined the "correct" outcome? His/her recommended medicine is not working, you are still sick, worse than the day before.

    The thing is, in that 15 minutes he/she had to make a guess, something that doesn't cause harm, so they play "wait and see" at no cost to them.

    But you already have the answer, based on your previous experience, how your body is feeling and the symptoms. Only if he/she had listened.

    • May4th on 28/06/2023 - 08:31
      +23

      maybe because you caught a virus and antibiotics won't do anything for your cold, and will cause side effects and faciltiate antibiotic resistance for no benefit to you? you know, what your doctor actually told you during the consult if you cared to listen.

      • turbochris on 28/06/2023 - 08:58
        +12

        Seems like OP listens with their mouth instead of their ears.

        • smartazz104 on 30/06/2023 - 08:32

          Sounds like they breath with it too.

        • MrFrugalSpend on 04/07/2023 - 21:32
          +1

          Indeed, even still in this comment above, after it being explained several times by multiple people with credible experience and references OP is saying
          "something that doesn't cause harm" despite it being repeated explained superbugs and antibiotics resistance risk is very harmful;
          based the whole thing on "unwell for a few days" - so is expecting a result on sickness in that time;
          then after the appointment "still sick in the afternoon", - OMG :-O !! so now expecting to be cured of a cold in the same afternoon of the appointment!?;
          "then a second sickie" - okay so now apparently thinking antibiotics are justified for being sick the next day after the appointment….c'mon, seriously!? Sickness regularly takes 1-2 weeks to improve then sometimes coughs etc linger for a month - I'm guessing by the fact OP got no antibiotics and then is still alive today ~1 week later by the recent activity, OP didn't need life-saving antibiotics and lives to tell the tale !

          I can't see what is so hard for OP to understand that using your own immune system to get over being sick is the best cure… then only get antibiotics if an infection (e.g. bacterial) needs help 2 weeks+ later or if more serious sooner based on a competent medical opinion

    • mrvaluepack on 29/06/2023 - 08:45
      -1

      Agree with you on this Op, the GPs are all about the repeat visits and filling their schedule.

    • diazepam on 29/06/2023 - 19:47
      +2

      His/her recommended medicine is not working, you are still sick, worse than the day before.

      Because if you understood anything about the immune system / inflammation and it’s interactions with bacteria you’d understand that you don’t get better immediately overnight

      You clearly have 0 idea based on all your comments

  • payless69 on 28/06/2023 - 02:58
    +1

    My dog has incontinence and required hormones to fix it.
    Since dog medicines are not subsidized I could ask my doctor if he can place my wife on HRT and give them pills to the dog?

    • morse on 28/06/2023 - 04:11

      Some people who have a friendly GP do actually do this. Not so much hormones but anti inflammatories. I was always concerned that later other docs might question my history if been taking something I didn’t actually need so never did it with our dog, but I do know people who do it. Conversely I know people who get scripts for their do for themselves - I definitely don’t endorse this but it’s a thing.

      • greatlamp on 29/06/2023 - 08:51
        +1

        You can buy voltaren tablets without a prescription, no need to go through this game.

        • buckster on 29/06/2023 - 09:39
          +1

          Pets usually get given Meloxicam though, which isn't OTC.

    • drfuzzy on 30/06/2023 - 06:43
      +3

      A better strategy is to find a new wife who is already on HRT.

      • payless69 on 30/06/2023 - 08:45

        I thing I should have learned from our beloved Gerry Harvey!

  • May4th on 28/06/2023 - 08:29
    +19

    it's really quite simple OP, you are really not there for the doctor's advice, you already "know what your body needs" and want someone who actually has the qualifications to inkstamp a prescription, which the said trained/qualified person has advised against the very thing you seek.

    so you can either go to medical school, get those qualifications and prescribe it yourself if you are still so inclined once educated, or you can make a post on ozbargain to whinge about it. the floor is yours.

    • Trance N Dance on 28/06/2023 - 08:44
      +2

      If they live in VIC, WA, or NSW they'll have to move to a different state or territory, no self prescription of S4 and S8 drugs in VIC and no self prescription for the purpose of self-administering in WA, although not strictly prohibited NSW considers it improper to self-prescribe.

      • May4th on 28/06/2023 - 08:57
        +1

        you can still prescribe, it's just frowned upon in certain states and illegal in VIC/WA for S4/S8 that you can be prosecuted. but that's beside the point.

        • starvingartist on 28/06/2023 - 18:59

          it's not illegal to self prescribe but you will get in trouble with the Board :-)

    • drfuzzy on 29/06/2023 - 05:59

      I was denied self-prescription in Victoria recently. I rarely self-prescribe but that was first time I've been denied.

      • greatlamp on 29/06/2023 - 08:54
        +1

        It's illegal (yes it's in the Act, not just a guideline) for the pharmacist to fill the prescription if it's self prescribed.

        • drfuzzy on 30/06/2023 - 06:46

          I think it was added in 2017? I think it is relatively new. I don't prescribe often.

      • Save Medicare on 29/06/2023 - 22:38

        Shot in the dark but I'd also be asking questions if someone tried to prescribe themselves RCHOP!

  • Amazingly on 28/06/2023 - 08:47

    What happens if you go overseas for six months.

    Not pain meds but general things like blood pressure meds etc.

    Can you go in a chemist and get them in one go?

    • May4th on 28/06/2023 - 08:54

      Yes, with a Reg 24 script

    • Trance N Dance on 28/06/2023 - 09:01
      +1

      Get a Reg 49 script.

  • CurlCurl on 28/06/2023 - 09:23
    +8

    @ browser. Doctor has had 7 years medical training. You have had ……?

  • Rahonui on 28/06/2023 - 09:37
    +3

    "It is really counter productivity, wasting my time seeing them in the first place"

    Ironic lol

  • reactor-au on 28/06/2023 - 09:41
    +11

    My GP will only prescribe antibiotic's if there is clearly a bad bacterial infection not likely to go away on its own, or if an infection hasn't gone away after about 7-10 days and gets worse. Viral infections are way now common.

    The only sort of common recurring bacterial infection I can't think of is some people get inner ear infection from swimming because their ears don't drain properly and then they usually use wax or plugs because prevention is better than cure.

    TLDR, you don't need antibiotics most of the time, save your gut microbiome- it will probably help prevent future infections

    • EtherealArchelon on 28/06/2023 - 23:03
      +1

      Inner ear infections are otitis media.
      The type you get from swimming is otitis externa. Otitis externa needs ear drops (antibiotic, antifungal, steroid) not oral antibiotics.

      • reactor-au on 29/06/2023 - 01:55

        Well there you go, I'm sure there are other examples but they must be so uncommon that I don't know of them.

      • BikingScot on 08/07/2023 - 17:27

        Close, but middle ear infections are otitis media. The inner ear apparatus is deep in the skull and rarely gets infected but if it does, it's bad times

  • dmcneice on 28/06/2023 - 09:47
    +59

    GP here.

    There really is no "limit" to how much we can prescribe, only what we see as indicated.

    As for your amoxicillin request, this is actually one of the more uncomfortable consults for me, personally.

    Reason: It's rarely indicated, and if we do our job properly, its to explain to you why its not indicated, and not give you the prescription. Problem is - patients feel dissatisfied with this, even though we did our job "properly"

    The alternative of "giving you what you want" actually improves patient satisfaction, but is not best practice and can actually be harmful, even though patients feel like they get their money worth.

  • kallico on 28/06/2023 - 10:01
    +9

    Ah! the age of entitlement

  • jacross on 28/06/2023 - 10:44
    +3

    What is your condition you are trying to treat?

  • ColtNoir on 28/06/2023 - 10:57
    +4

    As someone who has asthma and often gets really bad chest infections, they will wait until you display the necessary symptoms to prescribe. An antibiotic won’t work as a prevention, potentially risking further mutations.

    My regular doctor who I’ve been seeing since I was 5 does however give me the prescription, only because he trusts that I won’t take them unnecessarily. Which I don’t.

    If I went to another doctor I wouldn’t expect this type of treatment.

  • 42 on 28/06/2023 - 13:56
    +9

    Maybe because over 80% of upper respiratory tract infections are viral where antibiotics won't help

    • BikingScot on 08/07/2023 - 17:28

      80% and the rest!

  • serpserpserp on 28/06/2023 - 14:26
    +4

    GPs there refuse to give me the script (antibiotics such as amoxicillin)

    That's because you don't have a bacterial infection.

  • Dognosis on 28/06/2023 - 14:58
    +5

    always gonna be good drs and bad drs.

    I feel as I've gotten older that GPs have gotten less 'caring'.

    I don't blame them at all though. It appears to be a shit job. High stress, ok pay, okay reward.

    I think bulk billing has become too expected in the field whereas it should just be for low income earners. If most of us agreed to pay a fair gap, the GPs would not be so pressured to push through patients.

    The amount of overheads they have to contend with compared to some other cushy jobs with less social value out their is criminal.

    • Kafkaesque on 28/06/2023 - 21:22
      +5

      hard to be caring and easy to become jaded as you get more people like OP

    • mrvaluepack on 29/06/2023 - 08:46
      -2

      Why high stress? And only ok pay? Lol.

      • greatlamp on 29/06/2023 - 12:58
        +2

        What is the consequences of making a typo in your line of work? Can you be sued? Kill someone?

        • mrvaluepack on 02/07/2023 - 13:03

          Yes and yes. Not just one person gets killed with a typo, hundreds and cause millions of dollars in infrastructure or equipment damage.

          • greatlamp on 02/07/2023 - 13:27

            @mrvaluepack: Ah, an engineer. I don't see Drs saying engineering is not a high stress job. Nevertheless you have the luxury of time which doesn't exist in the medical profession.

            • mrvaluepack on 02/07/2023 - 14:09
              -1

              @greatlamp: If I get paid $40-50 for 3-5 minutes of consultation work, I wouldn't complain as well.

              • greatlamp on 02/07/2023 - 17:38
                +1

                @mrvaluepack: So it is stressful work, but it shouldn't be paid as stressful work?

                It's closer to 15 mins as a best case scenario for the simplest jobs.

                Engineers are also paid highly for their skill and expertise, not based on how many hours a job takes. Aren't you being billed out at $200 to $300 p/h?

                I would have thought an engineer would be smart enough to understand that being a GP isn't a cushy job.

                • mrvaluepack on 02/07/2023 - 20:30
                  -2

                  @greatlamp: The company bills but we get a fixed annual salary no matter what and thats for like specialised consultants or energy/mining sector. Other areas is much more less than that.

                  And ive never had an appointment with a gp that lasted for 15 minutes. They always seem to want me to bugger off asap.

                  • May4th on 03/07/2023 - 11:05
                    +1

                    @mrvaluepack: that's lucky for you, unfortunately there are those less fortunate who requires 20-30 minutes when they are booked in for 10-15 due to their chronic health issues

                    fun fact: you get paid the same for a 19min consultation as a 3 minute consult.

                    might I suggest nothing takes just 3minutes during a proper consult (that is, any issue that requires a more than cursory history/examination/plan), by the time they open your file, stand up and get in you in the door and get you out the door alone takes 3min or more especially if you are elderly or mobility impaired. patients usually have a very warped sense of time, it's always a "quick one today." Most GPs would opt for a salary in a heart beat compared to the cumbersome underfunded Medicare we have today to actually have sick leave annual leave super maternity leave etc etc

                  • ColtNoir on 10/07/2023 - 20:31

                    @mrvaluepack: You mean, like a lot of doctors. If they’re not salaried, that $40 is before all their costs eg rent, insurance, continued education etc.

                • May4th on 03/07/2023 - 11:04

                  @greatlamp: the easiest jobs are always somebody else's jobs, especially if well paid..

              • BikingScot on 08/07/2023 - 17:32
                +1

                @mrvaluepack: Ha if only. Except from that goes the service fee to the practice to pay for the facilities, the nurses, the receptionists, the practice manager, then there's paying their own superannuation, indemnity insurance ($2-12k a year just to turn up), college fees, compulsory professional development training (50 hours minimum a year) etc etc etc. Oh and the $$$$ of HECS or other debt to pay back to do all the medical school years, the post medical school advanced training, courses and exams, so they can get to that wonderful place where they can listen to deluded people like OP argue that they know better

      • Dognosis on 02/07/2023 - 12:35
        +2

        I mean considering the amount of stress involved in the job, GPs don't get paid well enough.

        • mrvaluepack on 02/07/2023 - 13:05
          -1

          Come on…a quick 2 minute consultation for $30 - $50. I think they get paid well enough.

  • apple2016 on 28/06/2023 - 16:23
    +4

    when I have described the symptoms and explained it will get worse

    there is a reason you are not the GP.

  • jonkvh on 28/06/2023 - 16:54
    +1

    My GP has been barred from doing any prescriptions by the TGA for over 5 years.

    • MorriJ on 29/06/2023 - 00:11
      +2

      I think your GP maybe fibbing? I was under the impression the PRU (Pharmaceutical Regulatory Unit), state based Medical Councils and the HCCC (Health Care Complaints Commission) dealt with medical suspensions and removing the ability to prescribe?

      The TGA defines what can be prescribed and in what circumstances but was under the impression that the various medical bodies are responsible for who can prescribe.

      Happy to be told I am wrong of course; but a doctor who prescribes without legitimate authority/irresponsibly (eg not keeping appropriate records, high risk prescribing of drugs of dependence etc) are dealt with by the 3 organisations above and typically have their medical licence suspended which also suspends their ability to practice.

      • jonkvh on 11/07/2023 - 08:09

        Definately the TGA. The front counter staff know about it, everyone one in the whole medical centre know. My old Doctor retired so I was moved onto the TGA banned Doc, who apparently specialised in mental health care plans, which I knew nothing about, at the time.

  • sharks on 28/06/2023 - 16:56
    +1

    Sounds like you should be treating this with your regular GP if you have it happen twice a year but i’d think that you should be understanding the root cause and treating that instead if you’re relying on antibiotics on that kinda time frame. Health is complicated but you have to work with your GP and ultimately they’re the one assessing you

  • Eeples on 28/06/2023 - 17:22
    +1

    Can you get your regular GP to print off your medical history and also write a letter detailing your history and what they recommend to treat your recurring illness?

    You might then present this letter to the GP clinic to aid your case.

  • majuks on 28/06/2023 - 17:58
    +4

    I suggest OP to study medicine and then see how ridiculous his thought process is.

  • nix1016 on 28/06/2023 - 20:27

    Tagging on here. Do doctors have limits on blood tests? E.g, I just go say I’d like to get some preventative blood tests done such as vit d, iron, etc to see if I’m deficient in any?

    • EtherealArchelon on 28/06/2023 - 23:05
      +1

      If they're not clinically indicated, you can see something like a nutritionist who can write a long pathology form but you'll have to pay for everything.
      Also they're of limited benefits.

    • Eeples on 29/06/2023 - 01:39
      +1

      I think you get 1 free blood test per year. And follow up free ones if they find something. Under Medicare.

      But I’m not sure.

    • idonotknowwhy on 29/06/2023 - 09:19

      If you're having trouble getting that, tell them "I've started the carnivore diet, I need to test my D, iron, triglycerides, blood sugar, etc" and they'll do it.

    • Invert-Panda on 30/06/2023 - 22:54
      +1

      I'd probably have a chat with your GP in terms of why you're looking to check if you have a nutrition deficiency and go from there

      You'll get as many bulk billed blood tests as are necessary to diagnose and manage any illnesses you have. I have a few conditions so get a bunch of blood work every 1-3 months.

  • jzdhgkd on 28/06/2023 - 20:55
    +32

    Gp here.

    One type of gp - patient comes in, "I need antibiotics". Gp writes script "here you go", claims Medicare level B for 5 seconds of "work".

    Another type of gp (myself) - asks a history, does an examination and determines you don't need antibiotics at that time. Tells you to come back if things worsen. Explains for several minutes and argues with you why you don't need antibiotics. Loses you as a patient, earns the same amount of money for 15mins and therefore earns less money in the long term.

    You're basically saying the first kind of gp is a "good gp" when you just have no idea what you're talking about. You don't have a medical education so don't pretend you know what you do and don't need. Leave the difficult decisions to those with training.

    • iamtotoro on 28/06/2023 - 21:05
      +16

      Look after your self mate. You can only argue with stupid so many times.

      • jzdhgkd on 29/06/2023 - 00:59
        +7

        Thank you for the kind words. Over the years I've learned ways to deal with these kinds of patients (hence the "loses you as a patient" part of my rant.) The ones who just want antibiotics for their colds and flu will simply go elsewhere.

        The main problem is there's only so much a script of amoxicillin can treat and patients who routinely go to these "in and out" kind of GPs sometimes find themselves in strife eg C.diff as someone else mentioned earlier to simply being less effective for actual serious illnesses like a pneumonia.

      • plasmapuff on 30/06/2023 - 10:00
        +7

        Agreed! One of the ways I reconcile my own cognitive dissonance with this, is I accept that some people are just so health illiterate (+/- illiterate in general) that the arbitrary system imposed time frame I am allotted for the patient (15 min, 4 hrs etc) just won’t be enough to overcome decades of intergenerational social disadvantage and trauma that has led them to this point.

        I make a reasonable effort, but when I detect the subtle cues of resistance I just stop. Some call this planting the seed. I just call it preserving my own positive mental capacity so I can try to help the next patient.

        Realistically, all we are doing is course correcting. Fixing intergenerational social disadvantage is outside my zone of influence. Isn’t that a job for politicians? /s

        Thanks for fighting the good fight!

      • buckster on 29/06/2023 - 09:45
        +4

        Pfft, any person given a script for antibiotics is going to fill it immediately, or fill it down the line randomly when they feel ill at a future point without even seeing a doc.

      • jzdhgkd on 29/06/2023 - 10:41
        +5

        Our clinic is booked out every day from morning to night. We don't need repeat visits to ensure $$$. In fact we'd prefer no repeat visits to free up space for other sick patients to see us.

        In your example if I felt the patient was fairly unwell (fevers, looking lethargic, asthma sufferer etc) then I would certainly give a script "just in case". But if they were an otherwise healthy patient who has a sore throat who examines well then nope!

      • greatlamp on 29/06/2023 - 13:04
        +1

        Noone can make that diagnosis perfectly, it requires a swab. GPs take your symptoms and judge what is most likely based on their (at least) 10 years experience. If they get it wrong they aren't bad GPs, it's the nature of empirical diagnosis.

    • idonotknowwhy on 29/06/2023 - 09:22

      Hi GP,

      Over the years, I've had a few of those quick bulk-billing GPs tell me "You had a virus but it turned into bacteria" or "So the virus became bacteria" and prescribe antibiotics.

      Question: What the hell are they talking about? That doesn't make any sense.

      • buckster on 29/06/2023 - 09:51
        +4

        https://en.m.wikipedia.org/wiki/Opportunistic_infection

        Means that the effect of the virus helped facilitate a secondary bacterial infection

          • jzdhgkd on 29/06/2023 - 10:42
            +4

            @mrvaluepack: Not most of the time. Maybe 3-5% of the time. This is why guidelines exist and this is why antibiotics are locked behind go visits in Australia.

            However keep in mind that this is only a statistic that applies to the population as a whole. Every patient is different and any gp worth their salt will manage patients as an individual.

            I've got my share of patients who for some reason end up getting bacterial sinusitis more often than not and will provide a "just in case" script of antibiotics for them every time.

            • Save Medicare on 29/06/2023 - 22:44

              @jzdhgkd: My mate told me in India you can pick up meropenem from the local pharmacy without a script

          • buckster on 29/06/2023 - 12:30
            +3

            @mrvaluepack: No, because antibiotics have other impacts on the body, and contribute to resistance, and are not useful for prophylaxis unless a person is severely immunocompromised, in which case they fall in <.05% of people and would already have management protocols in place.

            And often, steps can be taken to reduce the likelihood of some secondary infections like sinusitis without need for antibiotics.

      • jzdhgkd on 29/06/2023 - 10:46
        +4

        They are probably expressing themselves incorrectly. Eg bacterial and viral sinusitis start off exactly the same way at first so that's why guidelines say to wait a week before reassessing and considering antibiotics. So a gp will probably say "it's turned into a bacterial infection" but not literally mean that the virus has mutated into a bacterium or anything like that.

        As buckster mentioned there are also opportunistic infections. Covid was one example where opportunistic infections were really quite common! HIV/AIDS is another example but obviously unrelated to any debate in this thread.

      • Radiopej on 01/07/2023 - 12:25
        +1

        The changes caused by the virus and immune system fighting (E.g. switching immune system into prioritising anti-viral response, build up of mucus, and inflammation that reduce drainage) mean that a proportion of people may then develop a secondary bacterial infection. This proportion varies between the type of viral illness, the patient's reserves (complicated by age, general health, etc), and their lifestyle.

        This secondary infection may be from organisms that are already present within the person, which find themselves suddenly living in a defenceless soup that can help them grow.

        In a patient who does develop a secondary bacterial infection, antibiotics are usually then helpful. But in a patient who develops a secondary fungal infection, it wouldn't be. Importantly, taking the antibiotics during the viral phase may not be as helpful, because it also affects your gut microbiome, which can then cause issues with diarrhoea, digestion, etc. Antibiotics are a double edged knife, and the doctor should use them when they believe the benefit of the intentional cut offsets the potential for the damage of the cut from the other side.

        A small proportion of the population may need prophylactic antibiotics - for example, people on immunosuppressive drugs following an organ transplant may be prescribed them. That's because the balance of probabilities puts them at higher risk from not having antibiotics than the side effects of having them. In a relatively stable patient, who doesn't exhibit hallmarks of bacterial infection, and can then be given appropriate antibiotics later in the event that it progresses to a secondary bacterial infection, it is better for both the well-being of that patient and the population to withhold those antibiotics until they are clinically indicated. Otherwise you're potentially giving patients diarrhoea and electrolyte disturbances following a systemic illness, for absolutely no reason.

        I know some doctors will write a prescription for antibiotics in advance, with a directive for the patient only to fill the script if they feel x and y after a set period, etc. I'm not against that in the view of a competent patient, who may have trouble coming back in, and has established a relationship where the doctor is confident they will follow directions. My friend has this exact experience of a secondary infection following COVID and other viral illnesses, so the doctor went via this route and asked her to phone the clinic again before filling the script he gave her.

        Absolutely nothing in the OPs posts so far suggest them to be that type of patient.

    • infinite on 29/06/2023 - 19:29

      This is the right answer. No debate.

      The real downsides we see for patients though are that most GP's no longer bulk bill, so "coming back if it gets worse" (which it usually does for most people) means they are around $70 - $100 out of pocket for having to double-up on appointments over the same issue. Then they still have to pay for the prescription med's anyway on top. That also gets complicated by most GP's having a wait time to secure an appointment of more than 5 days. So they end up then also ping-ponging between GP's to get basic stuff sorted.

      I found it very interesting from personal experience working throughout Asia that most of these basic antibiotics and steroid treatments are all over-the-counter purchases at any pharmacy and even corner stores, most have minimal restrictions on how much you can purchase. They sell the stuff by the tablet, tab or 10ml-30ml vial. There's very minimal issues with that system and it seems to work fine in those places, despite how easily abuse-able it is.

      No system is perfect I guess.

      • EtherealArchelon on 30/06/2023 - 01:34
        +1

        "There's very minimal issues with the system" - other than World Health Organisation calling tham at critical risk regions, pouring money in creating reports and task forces, BMJ dedicating 15 issues to the problem… yeah. Multiresistant bugs cause 20000 "excess deaths" in Thailand a year. China has the biggest problem with AMR and the govt made it illegal to seel antibiotics without a prescription in 2004, yet 70% of pharmacies still do.

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