Frances Dixon on antibiotic misuse

I overheard an interesting conversation the other day. One man was telling his friend about an inflamed joint he’d had a few weeks previously. He had gone to his GP and had eventually been admitted to hospital and put on intravenous antibiotics. He’d spent a few days in hospital, but had a holiday booked, so he wanted to be discharged. He was told the doctor would be busy for several hours and couldn’t discharge him, so he discharged himself (after noting down all the medication he was on).Then he rang up all his friends and asked if they had any antibiotics lying about. Worryingly enough, they did, and he then proceeded to take random antibiotics for the next week whenever his joint gave him pain.

What shocked me (naively no doubt) about this conversation was, firstly, the fact that his friends would just have antibiotics lying around, which suggests that they left various courses unfinished. Secondly, the fact that he just took a mix of antibiotics completely sporadically. Thirdly, the fact that his friend was nodding and agreeing with him, as though he had done exactly the right thing. It just concerned me (I think that is the right word) that he obviously had no regard for what his (highly trained and well informed) doctor had told him, and no idea how antibiotics worked. Also, the same goes for his friends and family who had “spare” antibiotics. I suppose I am biased in a way, and assume that everyone knows the ins and outs of drugs, as everyone I know does (as we are all medical students). But, equally, if my doctor prescribed me something that I didn’t understand, I would follow their instructions regardless, and not assume that I knew best. It was his attitude of “getting one over” on the doctor that really surprised me. From my (admittedly very limited) experience of meeting patients and talking to them, it seems that most people have an incredibly high regard and respect for doctors and always think the “doctor knows best.”

Maybe this man had just been having a bad day, but it seemed like he thought it was a totally normal thing to do. It was just an eye-opening experience for me, to hear a conversation like this, and it certainly made me think about the importance of informing patients about correct drug usage and the potential consequences of incorrect usage. I wonder, for example, if he would have behaved the same way if he knew that his actions could potentially be helping to create the next MRSA or resistant superbug? I seriously doubt he would have done. Also, taking the drugs in such an erratic, and frankly bizarre, manner can’t be beneficial to his health, and could in fact do him damage. It’s not going to clear his infection effectively, and the implications of long-term inflammation are not pleasant. When a doctor prescribes something to a patient, they should be able to trust that the patient will follow their instructions, just as the patient should trust that the doctor has prescribed the best thing for them. If this trust isn’t there (on either side) then it does make you wonder, why do doctors even bother? I don’t think I’ve ever heard a better argument for Directly Observed Therapy. A rude wake-up call indeed.

Frances Dixon is a medical student at Imperial College School of Medicine, London.