If you know me on Facebook, you might have caught my disbelieving rant about an OOH doctor I met last weekend. I’ve fumed about this all week and decided to write it just, if nothing else, to record that these infuriating incidents are still happening.
Last weekend Max went away, accidentally taking both sets of car keys with him. I’d had a cough for a week but started to feel a fair bit worse and there was some blood in what I was coughing up. I had a friend visiting and Max wasn’t due back till very late. Worried that I might get quite a bit worse while car-less and with 5 kids to take care of (and my throat/chest history suggests I am right to be careful of this) I decided to use the bit of time while I had back up to go to the Saturday doctor service.
I was seen quickly and the doctor agreed that a slight temp, the blood and my history suggested that antibiotics would be wise. I said that I was breastfeeding a child allergic to both penicillin and erythromycin and asked him to prescribe something that had no cross over with either of these. He asked me how old the child was I was breastfeeding and what their reaction had been. I described the reaction (stopped breathing for +20 seconds, had swelling and a rash with the first and a bright red pinprick rash within an hour with the second) and then said:
The doctor looked confused; “Two what?”
Me: “Erm… 2. He’s two.”
Doctor: “What? Two weeks? Two months?”
Me “No. Two years. He’s two years and a few months”.
Doctor: “well, that’s not indicated.”
I was baffled. I assumed he was going to say that it was not indicated to worry about it appearing in breast milk, so I began to explain that I had considerable anxieties about harming him this way.
Doctor: “no, it is not indicated to breastfeed a child of over one year old. It’s not indicated as required and not appropriate.”
Not surprisingly, I hit the roof. I told him that was not relevant to the conversation, not his business and that his information was not correct, that the WHO guidelines said it was entirely appropriate for 2 years and beyond.
He did not like being challenged.
He responded, when I told him an antibiotic that Bene was safe with, that he was not prepared to break the OOHS guidelines for me and prescribed Clarithromycin. I said I knew that had a crossover and he told me to take it or leave it and I’d have to decide for myself if I was prepared to take the risk. He told me I should have realised I was going to get ill the day before and gone to my own GP.
I left the room and went straight to complain; I did have the satisfaction of hearing him get a thorough bollocking for the breastfeeding remarks but was sent to see another doctor who was clearly also of the “we really don’t like patients who think they have any say in the matter” stance. He told me that the prescription had only a 10% crossover (a pharmacist told me they wouldn’t risk it and it was more like 30% risky) but was shown in BMA as ‘safe in breastfeeding’. The antibiotic I know Bene is safe with shows in BMA as “not suitable for breastfeeding’ because it crosses into milk (as does the one offered, but they’ve been listed differently).
He said, and I made him clarify it, that he would prescribe Azithromycin for Bene had he been treating him but he wouldn’t prescribe it for me because it might cross to the breast milk and reach him. I asked him if he was prepared to come to Bene’s bedside if the crossover caused him to be fatally damaged and he told me that he was going to do things by the book and that was the end of the matter.
So, one doctor told me it was inappropriate to breastfeed a two year old.
The second had the choice of two antibiotics which show trace elements in breastmilk but one could hurt my allergic toddler and the other wouldn’t; the doctor was only prepared to prescribe me the one that might hurt him because of a line in a book that was clearly not appropriate to the situation.
Brilliant. Since I couldn’t take the risk, I’m still coughing up gunge a week later. But I haven’t had to worry about Bene dying of an allergic reaction, so that’s good.
Within 25 hours we had our 3rd run in of the week with 111 and OOH (I won’t bother to describe the first, which did at least end with a really great GP). We’ve only recently moved over to 111 here, meaning we no longer get to talk to someone local and useful, we have to go through pointless questionnaires, wait for a ‘trained clinician’ to call back who then gets the OOH service to call us and then we have to go there; two whole extra calls to deal with. Josie had been soldiering on with earache for 3 days but it got far worse that night. She was very hot and in a lot of pain and her neck glands were poking out through her skin. I gave up waiting it out and called at 8pm. 111 said we needed a ‘trained clinician’, I said she would need OOH but they refused to put us through directly, though they can as they had done that 2 days before for Bene.
The clinician called back at 11.30pm she was asleep, tossing and turning and fretful. He said a bit of earache could be solved with a hot flannel. I explained her condition and what I had so far done and he said “oh, you need OOH.” We waited longer for them to call, till past midnight but they said we had to take her in as they ‘don’t visit children’ – even ones they’ve kept waiting in pain for 4 hours and are asleep. We argued a while about whether it made any difference whether she started ABs that night or in 36 hours time. I was patronised by them explaining they aren’t painkillers and it doesn’t matter when you take them :roll:. I then had a long argument about whether they’d give her stock meds at 1am if she did need them or whether they’d make us go to a midnight pharmacist with a sick 9 year old. Max took her in; she was the only patient but they had to wait 45 minutes because the computer system was down and the doctor couldn’t look down her ear without looking her up on the screen first.
She needed antibiotics. They gave her stock meds. Which was lucky for them as I might have actually combusted if they hadn’t.
Overall, Peterborough City Centre Out of Hours service made a pretty much almighty fail last weekend. They were WRONG, unthinking, inflexible, didn’t treat the individual situation, rude, heartless and impersonal. I was not impressed.