There’s more NICE can do to help doctors help patients, writes Simon Fradd
The National Institute for Health and Clinical Excellence regularly publishes guidance papers on self-limiting illness, most of which I stumble on inadvertently. Among them is the crucial CG69: respiratory tract infections providing guidance to GPs on the appropriate use of antibiotics for a range of minor ailments. So far so good – as a GP, I’ve now got clear guidance on when I should be prescribing antibiotics for minor illnesses and when I should be recommending alternative treatments. Even better, I’ve got the data to support what I am doing – well, that is if you want to plough through 121 pages!
But what I haven’t got is anything to help me persuade my patients that I’m following best practice guidelines by denying them antibiotics for their ear infection and that I have their best interests at heart. The trouble is that we have been overprescribing for years and patients have come to expect a prescription. If they don’t get it, they want to know why.
So I can blind them with facts and figures about the reduced efficacy of antibiotics and how the impact of overprescribing is becoming a public health problem. Or I can talk to them about the unwanted side effects of antibiotics and the data that tells us most minor ailments get better just as quickly using other treatments. I can also tell them that prescriptions for coughs alone cost the NHS more than £15m a year. Or I can talk them through the average length of minor ailments so they understand that it’s absolutely normal to have a cough for three weeks, an acute sore throat for a week and that the average cold will last for 10 days or so. I can do all these things but my experience is that often I’m just not getting the message across and patients are leaving feeling unhappier than when they arrived.
What I need is something that explains all of the above. Something I can give to patients to reinforce what I’m saying that they can keep as a reference for the future. Something that will reassure people that not getting a prescription is actually a positive outcome. I need my patients to understand when to come for me for a consultation and when to go to the pharmacy or to look online for best advice.
Effective communication is critical and not that long ago this is something developing patient partnerships would have provided but since that particular baby was thrown out with the bath water, we have to look elsewhere. Wouldn’t it be great to hand over a leaflet that patients can read on the bus going home giving them the latest advice on the best way to understand and treat their sore back, cough or indigestion? So as a champion of the new movement Self Care in Practice, I call on NICE to put their money where their mouth is.