I’ve started just started my second GP block. The morning started and we were given a little talk from the head GP about how we were great back when we had our previous placement etc. etc. One thing that we could improve on, however, was to include a management plan for each patient when we present the case to the GP.

Calm.

The four of us split apart, two of us go to one allocated GP and another 2 of us to another.

My first patient came in. A 17-year-old male.

‘What brought you in today?’

He replied beautifully. He had Tonsillitis six weeks ago and was prescribed 500mg phenoxymethylpenicillin to take four times a day. Since then his tonsillitis had cleared. Today, he was wondering if he could have his tonsils removed. He told me that he had had tonsillitis 6 times in 2017 and this once in 2018 and that this is a recurrent problem for him. I took his word for it. Easy.

I wrote down the management plan: ‘Refer to ENT surgeon for tonsillectomy’ and then just casually asked him to open his mouth, for completion sake, and used my mobile as a torch to look inside. It looked normal, which I assumed meant it was all clear to go through with getting it out. I called the GP in. I presented. I got to my management….

I was wrong….

Apparently, the indication for tonsillectomy is having seven or more documented cases of sore throats in the preceding year, or five or more such documented episodes in the preceding 2 years, or three or more such documented episodes in each of the preceding 3 years.  These sore throacts obviously had to be due to acute tonsillitis.

The highlighted word here has been ‘documented.’ As the GP looked back through his records, there was only one other case of tonsillitis one year ago. I’m not saying the patient was lying, instead he probably just didn’t come to the GP when he had his sore throats. He didn’t have his cases documented and so he did not meet the guidelines for a tonsillectomy.

In fact, in one study of women aged 20-44years, only 1/18 episodes of sore throat led to a GP consultation.  Most cases resolve spontaneously and don’t require antibiotics. Between 50-80% of infective sore throat is caused by viruses, so wouldn’t be treated by antibiotics anyway.

Also, for those that do go to the GP and get prescribed antibiotics… evidence suggests that this increases their intention to consult for future episodes.

SO, some people never consult the GP. And others will attend the practice every time.

Now, I’m not saying that the guidelines are wrong. If I wanted to look further into this, I would look into the costs of attempting a tonsillectomy, the possible complications, the list of other things the doctor could be doing instead. I would look at statistics such as the probability of further episodes of tonsillitis and costs of antibiotics etc. and then I would weigh it all up.

That’s quite a lot of effort.

I’ll leave that for the people who get paid for such effort. I’m just here to tell my stories, give my opinions and then mention a few facts along the way.

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Written by: Jamil Shah Foridi

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