Do GPs Have Prescription Limit?

My regular GP (General Practitioner) only works on certain days, so there's a backup clinic I go to at times of need. For some season a couple of GPs there refuse to give me the script (antibiotics such as amoxicillin) as requested on separate occasions, even when I have described the symptoms and explained it will get worse. They always brush it off by recommending over the counter alternatives.

It is really counter productivity, wasting my time seeing them in the first place, wasting money on ineffective medications, wasting more money to see another GP to get the script, while unnecessarily prolong the illness and discomfort.

What is it? Is there a quota on the scripts they cannot exceed? Or an indication they are less competent and unwilling to risk the wrong script? Or simply a business model to drive repeated visit?

Comments

  • +197

    Probably just want to avoid unnecessary antibiotic resistance. It's not like pain meds where it doesnt' really matter if you take them a few times a year. Studies suggest that 1 in 3 antibiotic prescriptions are unnecessary.

      • +40

        So you think doctors should go wild and prescribe more antibiotics because of car insurance and pig farming? Because yea they are the same thing, and why not lower all standards.
        Why even have doctors if we already have corporate farms to make decisions about our personal health

          • +19

            @[Deactivated]: You flew so far off topic so quickly that few are going to be willing to even try to discuss anything on your terms.

          • +20

            @[Deactivated]:

            Straw man argument

            Your exactly right - you went and built a straw man of animal farming and car insurance.

            Read on the Theory of Constraints, you may find today was worth learning something new

            The assumption I believe crentist (and myself) are making here, based on both your response here and your previous comment, is that because of antibiotic use in animal farming that there should be no concern about antibiotic use by humans.

            Whilst I understand the argument, would it not stand to reason that it would be beneficial to reduce any antibiotic usage, if your goal was to decrease antibiotic resistance. Yes, the ROI would not be comparable to reducing antibiotic usage in animal farming, but lets be realistic on what things we have influence on.

            Perhaps, you could provide some value and an answer to your own question!

            Because doctors are generally not owned by "big pharma". If you boil it down, doctors are tradespeople, and they have tools at their disposal to help do their job - alleviate/reduce/remove health issues in their customers (patients). The three biggest tools in that kit are surgery, medication, and the human body: many ailments can be resolved by giving your body time resolve it, to heal.

            OP reads as a doctor shopper seeking antibiotics that they may not need - note that I'm not stating that this is the case, but it is how I read it, especially if their doctor is refusing to prescribe and they're attending with a shopping list of symptoms and the drugs they want/need. It could be that they have very specific issues and know that X is what they need for it, but it could also be drug-seeking doctor shopping.

      • Tigger alert!!! :-p

    • +4

      As a doctor myself, it sounds like you've been seeing responsible prescribers as mentioned in this thread.

      • -2

        Several medical studies support different portions of the Dunning–Kruger Curve. For example, 1 study found that junior physicians who were less competent tended to self-rate their efficacy higher than it was demonstrated (point A). Comparison of self-assessments and peer assessments of physicians in internal medicine, pediatrics, and psychiatry showed that those assessed in the lowest quartile by their colleagues tended to rate themselves 30 to 40 percentile ranks higher than their peers. A study showed that the lowest-performing physicians are the least likely to accept objective feedback on their performance. In another study, physicians did not perceive negative feedback as accurate or helpful and did not plan to use it to change their practice. Some physicians, after a period of reflection, were able to accept the negative feedback and use it for change. Others not only refused to accept the feedback but also questioned its validity and procedures.

        Medical Trainees and the Dunning–Kruger Effect: When They Don't Know What They Don't Know https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594774

        Doctors are more extroverted and neurotic than their patients, researchers find https://www.bmj.com/content/381/bmj.p927

  • +159

    there refuse to give me the script (antibiotics such as amoxicillin) as requested

    Doctors prescribe medicines, they are not 'requested'….

      • +67

        If you have a condition that requires a prescription medication for a long term or chronic condition then a doctor will prescribe a repeat checking your history (and assuming you are due for another prescription)

        If you rock up and claim you need antibiotics (which are not used to treat chronic conditions other than in a very small number of specific situations) then the doctor needs to make an assessment on what is presented by the patient.

        Doctor shopping is a far more common issue than you might think. The uneducated doctor may be the original GP.

          • +8

            @browser: If you think you have a complicated condition, request a longer/extended consult when making the appointment or when you walk up to the desk in a walk in clinic so they can allocate you more time.

            • -4

              @Trance N Dance: Yep that's the point they want more money instead of just fixing the issue

              • @DrScavenger: It's not about the money but rather the amount of time they spend and knowing before hand that a patient requires more time is extremely helpful to keeping to schedule for those that run on an appointment style system. They actually earn less on a per hour basis for extended consults as the medicare rebate isn't double for double the amount of time but rather $X for up to 20mins and then $Y for up to 40mins. If docs were really about dollars they'll churn as many patients as possible per hour so they can rack up as many standard consults they can and keep appointments as short as possible. You'll see this at bulk billing places only so they can keep their hourly rate high.

          • +124

            @browser: The common cold is a virus. Antibiotics do nothing for viruses.

            • -2

              @Motek Benzona: Sounds like everybody are getting the world class treatment from their GP, or super healthy never needed to visit one. :D

          • +32

            @browser: If the alternative is to willy-nilly prescribe antibiotics, then yes. Antibiotic resistant bacteria is now a thing simply because doctors used to prescribe antibiotics without the necessary checks.

            I have several friends who want antibiotics every time they get sick. Their reasoning is that it worked in the past, regardless of whether it was coincidental, or caused by some other factor.

            That's not the way proper medicine is practiced.

          • +8

            @browser: The doctor prescribes what they think is most appropriate based on the information available to them - your symptoms, general health, medical history etc as well as their expertise.

            They're not there for you to dictate to them what you want prescribed. Maybe your regular GP has a different assessment, so you should visit your regular GP.

            It's hard to say without knowing why you need antibiotics. If it's for cold or flu, antibiotics are completely useless though I know some GPs will still prescribe it just to give their patients peace of mind despite most experts advising against it.

          • +3

            @browser: if you are sick, generally you don't need antibiotics.
            Antibiotics treat BACTERIAL infections, and even then, can be dealt with only as necessary if not minor / your body's immune system isn't able to beat without help.
            90% of the time, being sick is a VIRAL infection.
            It will clear up in a similar time period regardless of whether you have antibiotics.

            You may think your illness will turn into a bacterial infection, or is a bacterial infection. Even then, unless it is a serious one, the GP will err on the side of caution and tell you to get some rest and see how you go to avoid wasting antibiotics unnecessarily.

            Unnecessary antibiotics is not only a waste, it is very bad at building antibiotic resistance both for you and contribute to the risk of generating superbugs so that if you do get a serious bacterial infection, the antibiotics won't work as well at fighting them as they've mutated to evade them by unnecessary exposure.

            Your old GP is the one that has a problem and I'm guessing is old before modern medicine knew better than to hand out antibiotics all the time just to give you not much more than a placebo effect and feel like they've achieved something to justify you coming in and paying their bill.

            Most doctors will assume what you have is viral or even if it is bacterial, minor, and not prescribe antibiotics unless you really need them and won't get better without them because they should be preserved for when essential to protect their effectiveness and avoid risk of downsides. You should thank them for making a judgement that will mean if you really need antibiotics for a serious infection later it will work better, instead of acting like Michael Jackson trying to hit up his doctor for another fix even if it kills you!

            " treating viral infections with antibiotics in order to prevent bacterial infections is not recommended because of the risk of causing bacterial resistance: Remember that antibiotics do not work against viral colds and the flu, and that unnecessary antibiotics can be harmful."
            https://www.hopkinsmedicine.org/health/wellness-and-preventi….

            "Have you ever left your health care professional's office feeling frustrated that you didn't get an antibiotic for a sinus infection, sore throat or ear infection? If you answered yes, you aren't alone. Millions of people visit their health care team each year looking for antibiotics to cure infections. The reality is that if you have a virus that cause illnesses like bronchitis, sinus infection and the common cold, you don't need antibiotics to get better.
            https://www.mayoclinichealthsystem.org/hometown-health/speak…

            "To help mark World Antimicrobial Awareness Week, read on to learn about why doctors may not prescribe an antibiotic when you are sick.
            You may not have a bacterial infection. Antibiotics, which are part of a group called antimicrobials, only fight bacterial infections. These include post-surgery infections, dental abscesses, most urinary tract infections (UTIs), and strep throat, to name a few. Antibiotics won’t treat viral infections (like influenza, colds, and COVID-19), fungal infections (like vaginal yeast infections or thrush), or parasitic infections (like malaria). Other antimicrobials (antivirals, antifungals, and antiparasitics) treat those infections. "It can be harmful to your health to take unnecessary antibiotics. Antibiotics cause side effects, some of which can cause serious problems."
            https://www.sepsis.org/news/why-wont-my-doctor-give-me-antib…

        • +12

          The uneducated doctor may be the original GP.

          He's against vaccines. That's why he says they're "uneducated".

          • -4

            @Clear: My god is that the best you can do? Why even bother? You simply made up rubbish as opinion yes?

      • +1

        Yeah,that ain't the flex you think it is,but your hidden self assessment in the last few lines definitely ring pretty accurate.

      • +20

        JFC and they wonder why so many are leaving general practice. Bust your gut in high school scoring highly, bust your gut in med school to survive, bust your gut in GP specialist training….

        only for for Motek Benzona to call you an uneducated hack for the responsible prescribing of antibiotics to a patient they don't know, in an era of extreme antibiotic resistance. Antibiotics aren't eneloops ffs.

        • +2

          I hear you MessyG,but take comfort in the fact that that person is probably taking orders in a drive-thru and can barely spell Dr…I am.

  • +13

    wasting my time seeing them in the first place

    How?

      • +36

        Without a meaningful outcome.

        GP gives the correct outcome.
        That is what they are trained for.

        It is therefore 'meaningful'.

          • +23

            @browser:

            some becoming surgent

            They swell ?

            • -2

              @jv: Where's the auto-correction when you need it. :D

            • +2

              @jv: they could be insurgent

          • +5

            @browser: Guess who becomes GP? A crapload, it's currently one of the most sort after specialties, there are some who failed to enter the GP stream and ending up in anesthesiology. So is anesthesiology now the "bad" specialty?

            • -1

              @Trance N Dance: Hence "all due respect", only due if present.

              • +27

                @browser: The way you said it was akin to "I'm' not racist but…"

                You made it sound like the only people who become GPs are those who can't get into other specialties and are the bottom of the barrel. It was quite insulting. I'm not a GP nor a doctor but even I could see the disrespect in that comment.

                • @Trance N Dance: That was in response to JV's comment, which implies GP gives the correct outcome in general. Surely not everyone.

            • @Trance N Dance: LOL I wish, but does not happen mate

            • +5

              @Trance N Dance: It used to be 50% but now down to 15% go into GP, largely in part because of self entitled muppets denigrating the profession and their specialist training on par with every other specialty, and then the media pile on in recent years. Not worth the hassle or the poor recompense for all the work involved. Better pay driving a truck in a mine and you don't even have to finish Grade 10 for that.

          • +32

            @browser: And you’re wondering why you’re not having good experiences with GPs. If this is what you think of GPs and go into their office with a request list not for a medical opinion and a disrespectful attitude, it’s probably not surprising that it’s not working out for you.

          • +14

            @browser: If it's so easy, why don't you become one and write yourself all the scripts you want?

            • +6

              @CrowReally: 🤣🤣🤣 stop it.The kid needs spell check to write, you want that as a GP ?

          • +6

            @browser: With all due respect, your ignorance is showing.

            General Practice has been a specialist qualification since the 1990s, and like all the other specialist college, has selective entry, and multiple training exams. They also do extensive research. A specialist has an extremely limited scope of knowledge compared to a GP. They all sat the same entrance exams into med school, they all sat the same exit exams to become a doctor, and they all do specialist training. So no, they're not order takers. They give the orders to us non-GP specialists.

          • +1

            @browser: GP is a form of specialty training, they aren't anywhere near the level of fresh uni graduates

          • @browser: That's not how medical education works. You still must go through internship, a few years in residency, then a few years training as a GP registrar. If you complete all this, you become a GP.

            You don't just walk out of med school and start taking patients as a GP. You need to be pretty well rounded and know the roles of the other specialties to be a good GP as well.

  • +94

    Sounds like your GP is doing their job

      • +17

        What makes you think they didn't listen ?

        • -7

          If they did, you wouldn't have a chance to ask this question.

          • +13

            @browser: That is nonsense.

            What makes you think they didn't listen ?

            • -6

              @jv: If they did, there will be no post and no question.

              • +43

                @browser:

                If they did

                Maybe they did listen, then instead chose to do their job properly.

                • +21

                  @jv: pearl of wisdom I was told, is to stay away from the doctor that makes all their patients happy

                • @jv: maybe dr should explain that they listened and what theyre going to do.

                  too many doctors dont run an explanation of what they do and why theyre doing it

              • +7

                @browser: if they did what you asked them to do then they would be following your medical advise, the job for a doctor is to examine then provide the best outcome for the patient using their own medical knowledge, to prescribe a patient something they want just because they want it would be unethical, at that point they would just be drug dealers, you go to the doctor to get their advise about making you better, not to provide access to the drugs you think will make you better, and plus, if you took amoxicillin all the time and every time you got an infection it would stop working, you should only take it when you really need it

          • +8

            @browser: I have a child who claims that I don't listen because I won't ban her sister from eating every food she likes, asked her to give something back to her sister that she told me she took without asking and won't buy her guinea pigs.

            As I've explained to her, there's a difference between not listening and not following orders. If it's your example of not prescribing antibiotics for a common cold, then the doctor is probably listening, but not following orders. If it's something else, it would help to have the context. It's likely that the doctor is listening but disagrees with you, right or wrong. Not saying they're perfect.

            • +1

              @Miss B: This so spot on. It's also up to the doctor to explain all of this to the patient. I get the overwhelming feeling that the doctor did and the OP was always going to come and complain about it because they didn't get given 18 Guinea pigs

  • +65

    What is the point of this post? That's a rhetorical question - it's clear that this is 100% whinge. Doctors don't have to prescribe you medicine just because you feel like it.

      • +18

        I dunno - did you ask the doctor?

        • -4

          Because he has nothing to lost but everything to gain when the next patient walks in. Only I wasted my time.

          • +5

            @browser: easy solution, dont walk in and all issues resolved. You didnt need medications, as indicated by your ability to type these responses, so it's quite likely you survived and have not contributed to antibiotic resistance problem getting worse. Obviously some diseases can cause permanent damage if not treated soon, but I'm getting the vibe this was not the case. Therefore….

            Doctor has helped you save money on buying meds, taught you that you can survive without meds, saved you time in the future to not visit doctor for such matters, compound effect of time saved as time used more productively (infinite gain :O), saved medicare costs.

          • @browser: You weren't the only who wasted time there

      • +11

        Did you get tests taken that prove you were infected with bacteria that would be killed off by said antibiotics? If not then the doctor did their job right.

        • It's not as simple as doing a test to diagnose a viral vs bacterial infection. The diagnosis is based on clinical presentation

          • +3

            @inasero: Sure, but OP doesn't even want to go through the "test" route. They want to be prescribed antibiotics based on what they think they need. Not based on the doctor's judgement.

      • This here:
        "Clearly I was unwell, clearly it was a legitimate request, and clearly it wasn't in excessive quantity."

        Unwell - however, antibiotics may not treat this effectively or is the wrong treatment. Did you ask why?

        Legitimate - the Dr weighed the risks and their learned medical opinion was to not prescribe antibiotics, in this instance. Do you know why?

        Excessive - no, not true, antibiotics need a set course to be effective, taking less will not work properly, as it effects all sorts of bacteria and that can be worse if you don't take a full course.

        It is frustrating when you are sick, you want to be better.
        Do you know what is making you sick or what is wrong?
        What did your GP and you discuss as the reason for being sick, and often it seems?

        Those the important things you should to talk to the GP about.

      • +1

        easy question to answer, it is not the correct treatment for the condition you have. Either their opionion was it was viral, when antibiotics should only be used to treat a bacterial infection, Or even if possibly bacterial, it may be minor and they want to see if you are going to get better on your own and build some immunity of your own without the downsides.
        Just because you have something doesn't mean it must be hit with antibiotics.

      • +5

        You didn't spend the money on a vending machine for antibiotics. You spent it on an assessment.

        That assessment was that your perceived need for an antibiotics was most likely incongruous with to your disease presentation, unlikely to provide meaningful relief in relation to the side effect profile, and likely to contribute to antibiotic resistance while doing so. If you find you're repeatedly getting sick then ask your GP to discuss whether you get sick more often than is to be expected and if you have any underlying reasons for why that may be so.

        There's a difference between helping a patient and enabling them. If you want to dictate terms for prescribing a medicine, go to medical school. What you're describing wanting isn't help, it's a need to feel in control and dictate terms, which you should reflect on.

    • +31

      OP sees general practice as a transaction rather than a professional consult

      • -6

        I think its the other way around these days pal

      • -6

        I'm sure there are exceptions, but to many they are just running a business. Maximum turnover with minimum risk in the shortest time.

        They take your body stats, write scripts, type up referrals, send you to physio, or go see a specialist. Basic stuff, not everyone has high "professional" standard.

        I have had really good ones, but retired, hard to find good ones these days. My regular is okay, I wouldn't swear by him, but he has been understanding and knows the history. He has reduced from 5 to 3, and now 2 days a week. So his availability is becoming an issue.

        • -2

          We had to get a home Doctor out for our Son on 20th.

          I accidently booked 2 different places (long story)

          1st "Doctor" came out. He did nothing whatsoever, Looked at him, said "does he have asthma" then said "there is nothing wrong with him, tell the boy to get out of bed" and left

          I knew this was not true.

          It was then i realised i booked the 2nd one as well so we let them come.

          She thoroughly examined him and told us the flu thing had now become flu AND a bacterial chest thing and said he needed urgent antibiotics. She went to her car to get us some as the pharmacy was closed

          Now, if the comments of the usual suspects are correct on here i should have just shut up and listened to the first "quack" and nodded politely otherwise i am an anti vaxxer anti mask conspiracy theorist who should blindly trust others.

          And you wonder why they made the movie Idiocracy?

          • +8

            @Motek Benzona: Treating a bacterial infection doesn't make you anti vaccine or anti mask. A mask however for the flu would certainly help prevent (not stop) spreading the infection further.

          • +3

            @Motek Benzona: Move on.

          • +10

            @Motek Benzona:

            the flu thing had now become flu AND a bacterial chest thing and said he needed urgent antibiotics

            If someone needs ‘urgent’ antibiotics for their ‘flu thing’ they would most likely be going to hospital for sepsis or something. If it’s that urgent it would be very unlikely that they would leave your son at home. Changes are it’s just a difference in clinical opinion with the second doctor more happy to take the resistance risk with the antibiotic. No home call doctor would take the risk of not sending and acutely unwell child to hospital.

            • -2

              @morse: Yes thanks for the enlightenment.. Tell me, how do you know he has not been taken to ED before this earlier in the week? Are you saying i am making it up?

              Its IRRELEVANT where YOU think he should have been as the whole point of the post was to highlight the inconsistency of so called medical professionals in 2923, to enhance my agreement with the OP. Is that ok?

          • +1

            @Motek Benzona: In all seriousness you should get the flu vaccine. It's nasty and going around at the moment.

            • -3

              @811b11e8: Hmmm, funny, In the past month the vaccinated wife had b and the chest thing, both my kids have had "b" and the chest thing for one of them yet, here i am happily unvaccinated and i did not catch any of it DESPITE being the sickest i have ever been in my life with other things (not related) and being so called "High risk"

              (everyone is well now)

              Ill stick to my immunity thanks.. seems to be working

          • @Motek Benzona: There's nothing wrong with a second opinion and good doctors will always encourage it if you're not happy.

  • +8

    If you dont like the gp move on…

    • -3

      Yeah, that's the plan. Being a backup clinic, I don't take notice of the GP's names, but I have since looked them up and will make sure to avoid.

      The clinic is conveniently located, hopefully just isolated GPs doing funny things, maybe other GPs at the clinic are more helpful. Possibly explains why these 2 GPs were available while others were busy.

  • +23

    Limit? No, although if reviews of their prescribing patterns show an abnormal amount of prescribing a certain drug/kind of drug they may be brought to question and provide justification.
    Restrictions? Yes, depending on the state, there are different restrictions on what medications they can prescribe.
    Responsibility to adequately prescribe S4 or higher medications to a professional standard? Absolutely, especially when it comes to antibiotics and a major concern for antibiotic resistance. The days of thinking if a doctor doesn't "prescribe" you something or at the very least antibiotics they must be bad needs to stop; it's antiquated and just flat out wrong. That and thinking "my regular doctor does it" and if you don't you must be bad, did you ever stop and considered that it could be your regular doctor that is prescribing to old standards and is the one out of touch?

    • -4

      There's always a balance, sure in a perfect world one can press the pause button, seek medical attention for the mildest cold, rest, go to hospital for all sort of scans just to be in the clear. But in reality the world doesn't stop just because you get sick, you still have to deal with all sort of issues, and need to get back up running as soon as possible, not running to and from GPs and clinics.

      • +32

        medical attention for the mildest cold

        Antibiotics won't help a cold.

        • -4

          Was an example, out of context.

          • +22

            @browser: Then stop using it….

            • -3

              @Forfiet: That was 3 hours ago, people keep bringing it up after.

      • +2

        You don't get to take antibiotics because it is convenient!
        If with the help of your old GP you hit them up unnecessarily a couple of times a year it could be you that breeds the next superbug that gives you or someone else you spread it to who may be even more vulnerable an infection that becomes more serious, and when competent doctors try to stop that superbug killing that person with antibiotics when they are actually needed (possibly you, or a loved one) they don't work and they become seriously ill / get sepsis or die?!!

        All possible because you've had 20 hits of the same antibiotics so you can get back to work 1 day earlier and bred antibiotic resistant bacteria as a result! So I hope you have your answer now of why they have limits, in effect yes they do, as we now know better than we used to, and modern doctors know antibiotics are precious and dangerous and should be used with caution for the sake of public health. If your old GP doesn't understand that, hopefully they step down from 2 days a week to 0 soon as it sounds like they were educated 50 years ago! They should be used when you are so sick you are going downhill after a few weeks, or to save your life.

  • +3

    What are your symptoms? What do you believe is the diagnosis?

    • +21

      Apparently the common cold so that rules out antibiotics.

      • -7

        That was a bad example, now things are just getting out of context.

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