The Medical Reading Has Piled Up

So here are some snippets and links:

“Delayed prescribing of antibiotics for upper respiratory tract infection” has once again reared its head in the pages of the BMJ. The use of delayed prescribing is advocated, so a script is printed off but not given to the patient, the patient is asked to return for a script if the symptoms don’t clear. Trials suggest that this approach has the same or lower rates of re-attendance for the same illness than not prescribing at all. Guidance should be given to parents and patients:

• Children with otitis media should wait for no longer than 72 hours after the first consultation when significant fever or otalgia persists, or for no longer than 10 days where there is persistent ear discharge.


• In sore throat the delay can be 5 days.


• In lower respiratory infection 10 – 14 days.

I feel uncomfortable with the lower respiratory tract advice. Perhaps this is appropriate for the patient with a non febrile cough, but it seems important to exclude asthma, patients with chronic lung disease and those with pneumonia!

The BMJ has sound advice on the impending influenza pandemic. I must remember to get my vaccination booked again this year, even though the predicted pandemic strain will not be covered.

Perhaps more controversially, the same edition of the BMJ has an article proposing that we rename heart failure as cardiac impairment. The rationale for the change is that heart failure is a confusing title for doctors and patients alike. I am reassured to learn that there is a test for cardiac impairment (HF), and if we take the time to measure the BNP (B-type natriuretic peptide) we have an indication of how much the heart is struggling which we can monitor over time to indicate response to treatment! I must remember to stop asking patients how breathless they are, how far they can walk and what things they would like to do that their breathlessness stops them doing as indicators of treatment response, I just need to measure the BNP instead.

A reminder to search for the splenectomised in our practice population was the final editorial in this most pertinent of BMJ’s. I should ensure that all such patients are vaccinated against pneumococcus, HIB, meningococcus type C, and on lifelong penicillin (or erythromycin in the penicillin allergic). Also I must remind them to wear a warning bracelet.

Finally for now, “The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales” Author(s): John Strang; Janie Sheridan; Claire Hunt; Bethanne Kerr; Clare Gerada; Michael Pringle BJGP 2005; 55: 444-451 was a survey of GP’s to identify what role they were playing in the provision of prescribing services. The paper was based on a 2001 survey and concluded that although the number of GP’s providing a prescribing service was on the increase the quality of prescribing was not high. I found the paper depressing because I’m sure the authors are aware that since 2001 there has been a major initiative led by the RCGP to educate GP’s in the provision of high quality care, including prescribing initiatives. The authors are running the risk that the work of GP’s with substance users is not highly valued. Some follow up correspondence (Prescribing to substance misusers Stephen Willott, British Journal of General Practice Volume: 55 Number: 517 Page: 638) supports my view. I’m still disappointed that the authors published.