Colds and Flu’s
July 12th, 2009 by Dr WheelerSnuffly nose? Bit of a cough? Coming to the doctors is for many people an immediate response to this scenario…. but are they doing the right thing?
Figures vary – but it is probably fair to say that about 90% of sore throats are caused by viruses. These are organisms which (unlike bacterial infections) are not amenable to treatment with antibiotics. Sore ears in children, acute bronchitis (a chesty cough that doesen’t make you especially unwell and can last for weeks), runny noses and sinusitis are all in the same rough grouping. In short – with the best will in the world your GP won’t be able to do anything for these conditions, but they will eventually get better by themselves.
Doctors however are human beings; they like to think that they can help… even if they have a sneaky suspicion that they can’t. They are also susceptible to pressure, and have been known to accede to patients demands even if it wasn’t technically the right thing to do!
On the other hand – several studies have shown that Doctors greatly over-estimate how much their patients actually want antibiotic treatment, leading to inappropriate prescriptions that might have been avoided if better communication had taken place. The onus is on the doctor to make sure that this doesn’t happen, but the patient has a responsibility too… as a demanding patient can often lead to bad medicine.
GP’s and their patients aren’t the only problem however – Possibly 70% or antibiotic prescribing is for animal use, and in countries that allow the public to self medicate without a prescription antibiotic overuse at incorrect doses and for inadequate time periods compounds the problems of overzealous use of these drugs.
These problems unfortunately are not minor – apart from medicalising self limiting conditions, causing diarrhoea and the occasional serious allergic reaction; antibiotic over prescribing is causing massive issues with Drug resistance. There has been little advance in antibiotic research since the 70’s – and we are already seeing potentially very dangerous strains of bacteria emerging around the world (MRSA probably being the most well known at the moment.) There is an interesting article on the subject here.
So what should we do? Well, GP’s can start having more meaningful conversations about treatment decisions with their patients for one. Patients in turn will need to take on board this kind of advice and trust that their doctors are acting in their best interests.
Life is complicated however – and some people will need treatment – so who needs to see the Doctor, and who should deal with it themselves and save an appointment slot for someone who really needs it?
I can’t give you a precise answer – though the common sense approach is usually pretty good in my experience. If you are usually fit and healthy, have a sore throat, cough or cold, but are able to drink plenty of water and dont feel really terrible, then you won’t be needing treatment other than the usual rest, fluids and possibly some paracetamol. If on the other hand there is something unusual going on: a funny rash, hallucinations, inability to drink, neck stiffness / severe headache or confusion (i.e. what we would class as ‘septic’ symptoms.) Then you certainly need to see a doctor ASAP – phone and get advice! I would normally say the same for flu as well… but of course with swine flu about you should really speak to NHS24 / your GP about flu like symptoms at present (see the upcoming ‘swine flu’ post for more info!)
Kids who look fine can usually be left to cope at home with their parents – though we would have a much lower threshold for worrying about children, so don’t be afraid to bring them in if there is any doubt in your mind (a mums gut instinct is usually better than a doctors medical school training!) If patients are below the age of 2 or above the age of 65 it is probably best to come in, or at least chat to the doctor on the phone about the case just to be on the safe side.
NICE have come out with some more formalised guidance here, though it is not aimed at the layperson specifically, you may find it interesting to see how your doctor is thinking things through for you.
So – in summary. Viral infections are common and are very rarely dangerous. If you are between 2 and 65, fit and healthy but have come down with a bug then you could probably deal with it yourself at home – unless you have one of the serious symptoms outlined above, or think it might be ‘the flu.’ If in doubt then phone and ask for advice.
