This Week
PIC OF THE WEEK
SYRIA Dr Husam Hamdan( right) looks at an image about oesophageal atresia, sent by a paediatric surgeon, as he performs surgery at the Damascus Countryside Specialized Hospital in Douma last week. Due to the complexity of treating the one-day old patient with the rare congenital birth defect, Dr Hamdan contacted the surgeon living outside of Syria to provide guidance via a video messaging app. The consulting surgeon viewed the operation with the aid of a live video feed. Due to the deteriorating security situation in the country, there are no other paediatric surgeons available.
Photo: Mohammed Badra / AAP
Journal Talk
Michael Woodhead
SNAPSHOT
Female death rate: 130 per 100,000
Is resistance developing to antibiotic advice?
IT’ S often said that GPs are specialists in managing uncertainty. Unfortunately patients are not, at least when it comes to using antibiotics.
While public health campaigns have long drummed home the message that coughs and colds don’ t need antibiotics, individual patients still feel uncertain about exactly how antibiotics should be used for themselves.
This is evident from interviews conducted with 32 people who were recruited on a Queensland university campus.
Published in BMC Public Health, their responses show that many people have only a vague notion of what antibiotic resistance actually is— some thought their body would develop resistance to antibiotics, while others thought antibiotic molecules were losing their potency.
A common theme was that antibiotic resistance was an“ invisible” problem with no tangible impact on the individual or their family and friends.
MALIGNANT MORTALITY Cancer remains the main cause of death in Australia with lung cancer claiming far and away the most lives.
Total deaths 2016: 46,307
LUNG CANCER PROSTATE CANCER
BREAST CANCER PANCREATIC CANCER
RECTAL CANCER LIVER CANCER COLON CANCER BRAIN CANCER
OESOPHAGEAL CANCER MELANOMA
Encouragingly, most people were aware that antibiotics were not meant to be dished out willy-nilly. But when it came to their own situation, many complained they never received a good explanation from their GP as to why antibiotics were not appropriate for them.
Unsurprisingly, those feeling left in the dark often went online seeking information, or took advice from friends and family.
Uncertainty was a problem even when people did receive antibiotics from their GP, particularly when given as a delayed prescription. Such scripts left some patients feeling uncomfortable, suspecting their GP was unsure of the diagnosis and was just fobbing off the decision to use antibiotics.
“ Sometimes they’ re like:‘ Oh just keep it until you need it.’ I’ m like... what? How will I know if I need it?” said one female respondent.
Lack of clear instructions also explained why some people stopped taking their antibiotics once they felt better, and saved
8,406 3,248 3,004 2,911 1,914 1,864 1,752 1,439 1,338 1,281 leftover pills in the medicine cabinet so that“ next time you get sick you start with that, you don’ t even need go to the doctor”.
Similar confusion was seen when antibiotic prescriptions came with the option of repeats and patients were left to decide for themselves how to act.
The reassuring news was that most people were strongly influenced by what their GP told them. The researchers therefore suggested that appropriate antibiotic use would require better engagement between GPs and patients.
“ Overwhelmingly, when describing what they expected from a GP consultation, consumers said they wanted to be listened to. Consumers also expected the GP to … explain their findings, treatment options, and decisions, and to answer any questions,” they said.
“ Most consumers would accept the GP’ s decision not to prescribe an antibiotic if it was clearly explained,” they concluded. BMC Public Health 2017; online.
Male death rate: 201 per 100,000
QUOTES OF THE WEEK
“ Pain dissipates and anxiety fades in the presence of loved ones. Few things console the elderly and give them more purpose than knowing that they matter to someone.”
Melbourne oncologist Dr Ranjana Srivastava worries about the erosion of our respect for the elderly.
“ This is clearly a ludicrous outcome.”
AMA vice-president
Dr Tony Bartone says Practice Incentive Payment reforms will leave practices worse off, even when they commit to implementing quality initiatives.
“ Having cancer is like being pregnant. You are absolutely flooded with information, much of it unsolicited.”
Breast cancer patient Elaine George tells the ABC that a diagnosis of metastatic disease left her overwhelmed.
“ They don’ t take us seriously until we start industrial action.”
Adelaide hospital doctors have reluctantly gone on strike over a pay deal, says Dr Laura Willington, president of the SA Salaried Medical Officers
Association.
Source: ABS, Causes of death 2016 www. australiandoctor. com. au 27 October 2017 | Australian Doctor | 33