If You Have Yourself For Your Doctor, You Have A Fool For A Patient!

This saga reminded me forcefully of the above saying, which has more that a grain of truth!

Patient speaks out after online prescribing ‘ordeal’

One Australian woman is warning about the dangers of bypassing a GP, after ineffective medication for a UTI left her fighting for life in hospital.

Michelle Wisbey

03 Nov 2023

When Abbey Smith developed a urinary tract infection (UTI), she thought she would log into an online script service for the first time.
 
Little did she know that just days later, that decision would set off a chain of events that would land her in a hospital bed fearing for her life.
 
The Australian journalist shared her experience in an opinion piece for Yahoo News this week, entitled ‘Getting my prescription online almost killed me’.
 
Ms Smith’s story began around a year ago when she developed a UTI. Feeling the ‘familiar sting’ she simply jumped online, paid her $17.50, and a script soon arrived in the mail.
 
‘I dropped into my local chemist on the way to work and was only asked if I’d used the antibiotic before and whether I needed to be instructed on its use,’ she said.
 
‘I declined and off I went thinking how quick and easy the process was and how I’d use it again.’
 
But after a few days, Ms Smith could not keep warm – she was so cold her lips were turning blue.
 
She went to the emergency department but after an eight-hour wait and multiple blood tests, was sent home.
 
‘Just 24 hours later, after I experienced rigours, a fever and hallucinations of my deceased nanna, pop and first boyfriend, my housemate rushed me to the emergency room where I was told I was turning septic,’ she said.
 
‘The infection had spread to my blood, and I was admitted to hospital on the spot.
 
‘Before I was discharged a doctor explained the bug in my system was E. coli, a common cause of UTIs which is resistant to the antibiotic I was given.’
 
One year on and Ms Smith wrote she is only now starting to bounce back, and has vowed never to use an online prescription service again.
 
‘Since my ordeal, I’ve spoken to several other women who have been through the same thing as me, or know someone who has,’ she said.
 
‘My experience has stopped me from using online prescription services altogether.
 
‘These days, if I’m feeling unwell, I book into my local GP and take the time to go over my medical history.’
 
Ms Smith’s terrifying tale comes amid a rise in telehealth and online prescribing services.
 
In June, the Medical Board of Australia released new telehealth guidelines designed to clamp down on asynchronous prescribing services.
 
The new Guidelines: Telehealth consultations with patients took effect in September, and state ‘prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board’.
 
RACGP Expert Committee – Quality Care member Associate Professor Magdalena Simonis told newsGP Ms Smith’s story is proof of how ‘inefficient and potentially dangerous’ online prescribing can be.
 
‘Online prescribing is not as safe a method of treating medical problems as using telehealth or face to face with the patient’s regular GP,’ she said.
 
‘Online tick-box prescribing without a real-time, patient–doctor consultation fragments care and is not founded on the basis of an ongoing therapeutic relationship, and the flow on from this is that it is not good medical practice.
 
‘It is a warning to policymakers and politicians that fragmentation of care which does not take into account the differential diagnoses, the patient’s response to the treatment, and the need to review the patient by an expert in health such as a GP, poses a risk.’
 
In October, the RACGP urged governments to bolster telehealth access as part of its updated position statement, ‘The use of telehealth in general practice’.
 
It said telehealth must be of the highest quality, led by a GP, and thought of as complementary to face-to-face care, rather than a substitute.
 
Above all, it should be delivered by a trained healthcare professional, it said.
 
Associate Professor Simonis said the verbal and nonverbal exchange which occurs between a patient and a doctor who is familiar with them will often provide key information about the complaint.
 
‘It is not unusual for a person to associate their symptoms with what they already have had in the past, even if there might be a difference,’ she said.
 
‘UTIs are a classic example of this, where a patient might have dysuria and frequency but in fact has an STI or an undiagnosed pregnancy.
 
‘The need to come back or call for review “if things don’t improve, or new symptoms develop”, is key to preventing such unfortunate and potentially lethal outcomes.’ 
More here:

https://www1.racgp.org.au/newsgp/clinical/patient-speaks-out-after-online-prescribing-ordeal

Given this article comes from the GP College it is easy to suggest they are ‘talking their own book’ but they do have a point.

There is a reason one spends many years to becoming a doctor so one can prescribe and that it that you understand the risks of just this sort of scenario where the patient is not seen initially and then followed up while on the treatment!

As my old professor used to say “You rarely get into clinical trouble if you actually see the patient”!

A safe health system has necessary costs and protocols for a reason and if these are ignored problem will ensue.

I am not sure we have the on-line prescribing rules and regulations fully right just yet and I am sympathetic to calls for regular reviews of how things are working along with an effective system to identify when things go wrong.

David.