~c

What we see here is a failure of the hospital system to adequately address the needs of the patient. I have seen this kind of system failure many times in hospital and in general practice. Did we know about his holiday beforehand? It sounds like it was pretty important to him, I’m sure he probably told the staff at the hospital.

Could the hospital Dr have contacted his GP for a prescription?
Could someone have listened to the patient about his concerns?
As doctors are we really all supreme and all knowing, or in fact are we fallible?

Getting patients on-side rather than dictating to them what to do often produces the best outcome for all in my experience. If the patient did not understand why we wanted him to stay in hospital, or what the consequences of leaving were that may be one reason. Perhaps the holiday was so important to him that he felt he had no choice but to leave regardless of the consequences. I think most patients are fairly switched on about antibiotic use and misuse these days, but I agree it sounds as if he did not understand the differences between different antibiotics and what their uses are. That’s a pretty complex thing to try to explain to a patient though.

Better hospital-GP interaction may have been the key in this case - getting someone who knows him well to talk things through, although this may have been tricky in itself getting him an appointment and making sure he went etc. I think we all need to work on improving the primary-secondary interface.

Lois Paton, GP, New Zealand

Interestingly the evidence that patients need to complete 5 or 7 day courses of antibiotics for urinary tract infections is very weak. Three days is just as effective. So patients may be wise not to finish the course.

And since most prescribing of antibiotics in the community is for upper respiratory tract infections and almost entirely ineffective it probably is of no consequence that courses were not finished.

Finally MRSA is pretty rare in the community. The best way to avoid it is to stay out of the antibiotic rich environment of ht hospital.

So this surprises me less as I get older….

It is nice that you brought this into here but from the developing world; we have been seeing a very alarming scenario for the antibiotic misuse. The developing world like Nepal, every drug is the over the counter drug and everybody from all levels are prescribing all kinds of antibitics!!! The patient are also happy if they get the kind of medicine that makes everything Corrected without much waste of time and money! Therefore, it is the choice to prescribe all kinds of antibiotics together and may be without any investigations saving everything and curing over the counter!!!

This is sad!

Best wishes,
mati