Thinking more carefully about respiratory infections
Among the commonest presentations to family physicians are upper respiratory infections and related symptoms suchas cough. So we should treat these conditions well, just like any other illness. Most of the literature has focussed onwhether to prescribe antibiotics, and now we all know thatvery few respiratory infections benefit from them, so we should be extremely sparing in their use. Many doctors take the attitude: it will resolve by itself, so don’t worry about it. But many people find the symptoms annoying oreven distressing, and distract them from their activities.Symptom relieving drugs seem to be helpful, yet few doctors know the science of prescribing them, and this is often done badly, partly because it has been difficult toascertain the science underlying treatment of these “trivial disorders”. Few medical schools or training programs teach about them.
How much of our workload these conditions comprisedepends on the system in which we work: in countries suchas Malaysia and Hong Kong they are a higher proportion than in countries like Australia and UK.This is a change: 50 years ago, respiratory infections were much more common presentations there also. Yet it is doubtful that there has been any change in the number of infections experienced by each individual, child or adult. More likely itis a different response. The difference appears to originate in social expectations, mediated by the payment systems for doctors and medications. Where doctors dispense,primary care medicine is seen as a shopkeeper’s role, andpatients place greatest value on the medication rather than the consultation. In such countries, many patients perceivethe number of drugs prescribed as a measure of thedoctors’ worth. Consequently many doctors respond with multiple prescribing, often of compound drugs: what they think patients want rather than what they need. Most ofthese drugs are also available over the counter, and indeveloped countries that have separated the roles ofprescriber and dispenser, doctors do not prescribe them, since advising about them is largely the responsibility of the pharmacist. (copied from article)
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