The news section of the current BMJ (BMJ 2014;349:g5238) runs the headline “GPs feel pressurised to prescribe unneeded antibiotics”. The article states that:
• 55% of GPs felt pressurised by patients to prescribe an antibiotic (10% of patients expected antibiotics every time and a further 13% expected antibiotics most of the time)
• 44% admitted to prescribing antibiotics to get a patient out of the surgery
• 28% of GPs were not sure of the medical necessity of their prescription
• 24% of GPs felt there was a lack of easy to use diagnostic tools
It’s no wonder that antibiotic resistance is increasing!
• 55% of GPs felt pressurised by patients to prescribe an antibiotic (10% of patients expected antibiotics every time and a further 13% expected antibiotics most of the time)
• 44% admitted to prescribing antibiotics to get a patient out of the surgery
• 28% of GPs were not sure of the medical necessity of their prescription
• 24% of GPs felt there was a lack of easy to use diagnostic tools
It’s no wonder that antibiotic resistance is increasing!
I have two concerns. Firstly, patients must be told NO. There needs to be a public shift towards taking time off work to get over their viral illnesses; 6% of working patients demand antibiotics compared to 1% of non-working patients, and men with flu are more demanding (16%) compared to females (9%) ... don’t mention man-flu! Maybe the NHS, Public Health England and the Secretary of State for Health should revive the “Antibiotics – don’t wear me out” campaign or consider an antibiotic education TV campaign, along the lines of the recent “Change 4 Life”. I do sympathise with GPs as “patient pester power” is clearly a driving factor to incorrect prescribing and must be energy sapping. But doctors must resist; misuse, incorrect and inappropriate prescribing is leading to unacceptable levels of resistance and this has to stop.
My second concern is knowledge and diagnostic tools. I strongly believe we need better education regarding antibiotics and infection. I do not believe in Apps and “tools”to provide an easy answer. If doctors understood infections better they would apply their knowledge rather
than relying on Apps. However, let’s admit it, microbiology and antibiotics are possibly one of the dullest subjects in medicine, and the lectures were right up there with “liaising with social services*” or“evaluating research and medical
statistics*” (*insert your own least favourite subject...here) as “the one to miss” at medical school.
But it doesn’t have to be this way! Microbiology Nuts & Bolts is not an App but it will help with diagnosis and effective
treatment.
1) It is a pocket book - microbiology is too dull to be any bigger, and although small it packs a punch on content.
2) It is printed in full colour - microbiology is too boring to be in black and white.
3) It is clinically orientated - NO LISTS OF BACTERIA; it is presented by clinical condition (because your patients present this way) and clearly states the pesky bugs causing that condition and how to eradicate them the first time by selecting the correct antibiotic.
4) It is written by a clinical microbiologist but edited by a human! "Interesting" microbiological facts have been edited out (if you want/need this detail see the 4028 pages of Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases), Microbiology Nuts & Bolts answers the questions you need answering, concisely, and gives real examples to illustrate the point.
5) It is small and can be read in a week - read a section a day and your microbiology will definitely improve.
A Number 1 best seller on Amazon, Microbiology Nuts & Bolts is now in its second edition. Updated with information requested by doctors, e.g. extended information on fever in a returned traveller and how the heck do you take Vancomycin levels now? But don’t worry if you have a first
edition! The updated sections are available FREE as 14 postcard sized bookmarks just print them out and slot them inside your copy.
You may be asking yourself “Do I really need this little book?” Consider the following comments from another Consultant Microbiologist.
“As a clinical microbiologist I have to say that this is the book we didn't know was needed. Fortunately, David Garner realised this book needed to be written, and went ahead and wrote it. It is a work of genius in its simplicity. Unlike many (every?) other book about infection/microbiology it is written from the perspective of the frontline, routine practice of a UK-based clinical microbiologist, whose roles are clinical and laboratory microbiology, infection prevention and control, and antimicrobial stewardship, sometimes all at the same time, in normal working hours and out of hours (weekends and nights). In my experience it is a unique text, because its viewpoint is neither that of an infectious disease text, nor that of a microbiology text, but a confluence of the two, from a microbiologist's view. This is important because it deals with the daily reality of enquiries, usually from junior doctors, usually mundane (to microbiologists), but which aren't readily and quickly answerable from existing books or the internet. It is compact but detailed enough to be more than adequate for day to day use. It is not a reference text, nor does it claim to be. But it answers the questions we are most often asked on a daily basis, and at least one common request from a teaching perspective: the spectrum of activity of common antimicrobials. This section, part of a whole chapter on antibiotics, is summarised in a table and then is detailed by each antimicrobial class. The section also deals with antimicrobial stewardship in depth before an antibiotic is even mentioned by name. There is even a practical section on sensitivity testing in the laboratory. Other chapters deal with basic microbiology (clinical and laboratory, even how to interpret results and the importance of adequately completing the request form!), infections of different body systems, and emergencies. The chapter on infection control, which is practice-based, has a section on root cause analysis, which will be very familiar to UK microbiologists and infection control nurses. This is an invaluable text and will be useful for doctors, nurses, students and anyone involved in healthcare who deals with infection, whether in the UK or elsewhere. I have now relocated to Singapore and although the practice of microbiologists is different compared to the UK, the problems faced by doctors and nurses on the wards, and the
questions they ask us, are universal. Finally, any book that mentions "man 'flu" must be worth reading!” (Dr Papu De)
Read other Customer Reviews and Peer Reviews here.
There really is no excuse not to understand infections and microbiology. Please don’t rely on Apps, read Microbiology Nuts & Bolts, you’ll gain an invaluable understanding of microbiology and infection. This knowledge can then be used to help educate patients about their infections, help you select the correct diagnostic tests and interpret the
results of those tests and give you the confidence to choose to not prescribe an antibiotic when it is appropriate to do so. You can teach yourself how to be a microbiologist in a week...Try it and see.
P.S. Off on holiday for 3 weeks so no more blogs until September... visiting bears in Canada! :-)
than relying on Apps. However, let’s admit it, microbiology and antibiotics are possibly one of the dullest subjects in medicine, and the lectures were right up there with “liaising with social services*” or“evaluating research and medical
statistics*” (*insert your own least favourite subject...here) as “the one to miss” at medical school.
But it doesn’t have to be this way! Microbiology Nuts & Bolts is not an App but it will help with diagnosis and effective
treatment.
1) It is a pocket book - microbiology is too dull to be any bigger, and although small it packs a punch on content.
2) It is printed in full colour - microbiology is too boring to be in black and white.
3) It is clinically orientated - NO LISTS OF BACTERIA; it is presented by clinical condition (because your patients present this way) and clearly states the pesky bugs causing that condition and how to eradicate them the first time by selecting the correct antibiotic.
4) It is written by a clinical microbiologist but edited by a human! "Interesting" microbiological facts have been edited out (if you want/need this detail see the 4028 pages of Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases), Microbiology Nuts & Bolts answers the questions you need answering, concisely, and gives real examples to illustrate the point.
5) It is small and can be read in a week - read a section a day and your microbiology will definitely improve.
A Number 1 best seller on Amazon, Microbiology Nuts & Bolts is now in its second edition. Updated with information requested by doctors, e.g. extended information on fever in a returned traveller and how the heck do you take Vancomycin levels now? But don’t worry if you have a first
edition! The updated sections are available FREE as 14 postcard sized bookmarks just print them out and slot them inside your copy.
You may be asking yourself “Do I really need this little book?” Consider the following comments from another Consultant Microbiologist.
“As a clinical microbiologist I have to say that this is the book we didn't know was needed. Fortunately, David Garner realised this book needed to be written, and went ahead and wrote it. It is a work of genius in its simplicity. Unlike many (every?) other book about infection/microbiology it is written from the perspective of the frontline, routine practice of a UK-based clinical microbiologist, whose roles are clinical and laboratory microbiology, infection prevention and control, and antimicrobial stewardship, sometimes all at the same time, in normal working hours and out of hours (weekends and nights). In my experience it is a unique text, because its viewpoint is neither that of an infectious disease text, nor that of a microbiology text, but a confluence of the two, from a microbiologist's view. This is important because it deals with the daily reality of enquiries, usually from junior doctors, usually mundane (to microbiologists), but which aren't readily and quickly answerable from existing books or the internet. It is compact but detailed enough to be more than adequate for day to day use. It is not a reference text, nor does it claim to be. But it answers the questions we are most often asked on a daily basis, and at least one common request from a teaching perspective: the spectrum of activity of common antimicrobials. This section, part of a whole chapter on antibiotics, is summarised in a table and then is detailed by each antimicrobial class. The section also deals with antimicrobial stewardship in depth before an antibiotic is even mentioned by name. There is even a practical section on sensitivity testing in the laboratory. Other chapters deal with basic microbiology (clinical and laboratory, even how to interpret results and the importance of adequately completing the request form!), infections of different body systems, and emergencies. The chapter on infection control, which is practice-based, has a section on root cause analysis, which will be very familiar to UK microbiologists and infection control nurses. This is an invaluable text and will be useful for doctors, nurses, students and anyone involved in healthcare who deals with infection, whether in the UK or elsewhere. I have now relocated to Singapore and although the practice of microbiologists is different compared to the UK, the problems faced by doctors and nurses on the wards, and the
questions they ask us, are universal. Finally, any book that mentions "man 'flu" must be worth reading!” (Dr Papu De)
Read other Customer Reviews and Peer Reviews here.
There really is no excuse not to understand infections and microbiology. Please don’t rely on Apps, read Microbiology Nuts & Bolts, you’ll gain an invaluable understanding of microbiology and infection. This knowledge can then be used to help educate patients about their infections, help you select the correct diagnostic tests and interpret the
results of those tests and give you the confidence to choose to not prescribe an antibiotic when it is appropriate to do so. You can teach yourself how to be a microbiologist in a week...Try it and see.
P.S. Off on holiday for 3 weeks so no more blogs until September... visiting bears in Canada! :-)
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