Australian Doctor Australian Doctor 17th November 2017 | Page 29

Antibiotic guidelines still valid
Your Views
preserve the effectiveness of antibiot-
ics, and prescribing guidelines strike
a balance between adequate coverage
and minimising risk of adverse effects.
They are central to stewardship
programs to strengthen evidence-
based practice and where prescribing
differs from guidelines, prescribers
should clearly communicate their
reasons with the patient/carer and
document these in the patient’s clini-
cal record.
Guidelines are intended to guide
— they do not replace clinical judge-
ment or professional care and duty.
They are intended to support rational,
informed antibiotic prescribing deci-
sions — particularly in the empiric
setting of managing an infection
where causative organism and antibi-
otic susceptibilities are not yet known.
Rather than being negligent, appro-
priately following antibiotic guide-
lines while taking patient factors into
consideration is highly recommended.
Dr Pam Konecny,
infectious diseases staff specialist,
St George Hospital; co-chair,
Antimicrobial Stewardship Expert
Advisory Committee, Clinical
Excellence Commission, NSW.
EDITOR Regarding refusing patients’
unreasonable requests, I set up my
practice as private billing (‘The art of
saying “no”’, 3 November). It allows
me to spend longer with patients,
work less hard and still make a
reasonable income. I have strict
rules regarding certificates, scripts
and referrals which are cognisant
of the law and compatible with
the AMA code of ethics and with
my philosophy of how a practice
should run. They are all listed in the
practice brochure and consistently
applied, no matter the status of
the patient. I would commend this
approach to everyone. It is not the
end of the world if these rules are
not compatible with patients’ beliefs
and I have always been happy to
refer them to another practice. Very
few take up the offer and most of
those who do, end up coming back.
People will respect you in the end if
you have high standards and stick
to them.
Dr Stan J Doumani,
GP, Weston, ACT
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Virulent verbiage
(Doctors urged to drop the
jargon, 2 November)
I’ve had to pull up students for
gems like “Are you suffering
from frequency of micturition?”
and “Do you have retropatellar
crepitus?” as if they knew
these terms
attending
e before m
re c c l e
med school. A y patient
thought
his case presentation: “He
denies this, he admits to
that...” sounded like a police
statement. As far as he was
concerned, he didn’t
e “deny”
re c y c l e m
having a productive cough —
he bloody well didn’t have one!
Dr Michael Rice
(Health Care Homes won’t
solve chronic disease care,
27 October)
I developed programs for
patients with complex multiple
illnesses in the US for over
20 years. Professor Stephen
Leeder is right, the Health Care
Homes experiment will not
improve these patients’ care
or reduce admission rates.
There is confusion between
disease management and case
management. The number
of chronic illnesses is not
always the best indicator of
high medical utilisation. Case
management must address
the medical and non-medical
needs for these patients.
Unmet non-medical needs
can often lead to potentially
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Not so sweet Home
and many will turn away from
the medical media.
Dr Edwin Kruys (immediate
past RACGP vice-president)
It is somewhat disconcerting
to find the RACGP going
down the AMA road of making
pronouncements about matters
that are very politicised and fo