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:
“He’s two.”
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.
And then they report how overstretched the A&E departments are! Our local ooh uses the local hospital outpatients department, why would you spend all night waiting for them to call you back, to then go and sit in a hospital waiting room for another couple of hours, when you can bypass all that and go straight to casualty? Such a waste of public money I order to save money! Sigh!
It certainly feels like they just thoroughly broke a system that was working fine.
With you on the breastfeeding rant, completely. Fed my elder DD until she was 26 months and would have continued longer had I not wanted to conceive again, and it wasn’t happening whilst I was breastfeeding – but was pregnant again within a month of stopping. To suggest that it might be “indicated” or “required” for a restricted length of time is just barmy and like you say, some organisations recommend it for longer. Good for you for standing up to them.
This makes me very angry. I am always amazed by how few people know that the WHO recommends breastfeeding to two years and beyond, but there really is no excuse for doctors not to be aware – wilful ignorance perhaps. Hope you and Josie are better now xx
Not good.
Everyone knows 111 is unhelpful and manned by call handlers with a list, only serving to delay time to consult a doctor and adds to workload of OOH and ED . Sadly this is the way the health service is being pushed. The whole thing is unravelling: primary care is on its knees as everyone who can is jumping ship, secondary care is overloaded and the free-at-the-point-of-access can’t continue for much longer. Time to start saving for decent insurance.
I share the computer system frustrations. You cannot record or prescribe if it goes down unless you do it all by hand then spend just as long typing it up again and I suppose for children there are all the alerts to look out for too which requires an active system.
Would you consider not breastfeeding for the week of antibiotics you needed if there was no safe alternative option (and since no pharma does trials on breastfeeding mothers/babies can one really be certain any of these dugs are without risk?)? After all as you said, with your history, surely taking the antibiotics and holding off the feeding is more sensible than not taking the antibiotics. Presumably you went for treatment because of your fears of getting more unwell without them yet that is the exact position you are now in. (please don’t read as being critical – am not but hard to project tone in e mail – just curious where your risk-taking balance lies). Risk 1 Bene misses out on milk but mummy gets better. Risk 2 Bene gets to have milk but mummy poorly, low reserves (what does active infection do to breastmilk at this age – better or poorer quality I have no idea??) and things drag on.
Either way, hope all are better soon
There’s a whole lot more to BF-ing than the milk alone!
That exclamation mark suggests you think i dont realise that its not just about the milk and you are trying to provoke a BF vs non-BF arguement. To reiterate my point, I question whether missing out on a week of breastfeeding at the age of 2 yrs ie not reliant on it as a sole food source (putting aside all the othe BF stuff), in the grand scheme of things (104+ weeks so far plus however many onwards from here), really such a big issue if it means mum can get a chest infection treated rather than have it not treated & risk nasty complications?
The thing is though, I could have breastfed safely and been fixed with a prescription of an antibiotic safe for Bene. But they wouldn’t do it and I still cannot see their logic. It felt like sheer bloodymindedness.
I didn’t see this comment initially Sarah, I’m not sure why. But I can’t see how I could just stop feeding for a week anyway; he’s 2, demanding and angry and ill. We’d have a horrible and distressing week I wouldn’t have the emotional or physical strength for and at the end of it he’d almost certainly be weaned before either of us were ready. I’m with him all day and I feed him to sleep, just stopping would be cruel if not impossible.
Fair enough. Only you can make that decision as to where the balance lies. Intrigued what the antibiotic was that wouldn’t be prescribed. Was it something not normally used for chest infections? Have to say breastfeeding doesn’t ever cross my mind as an issue in drug choices hence my query – lifelong learning for ignorant doctor etc etc
Um. So, they wanted to give me penicillin or erythromycin but I said no in case it crossed to Bene via my milk. He offered clarythromicin but I felt (on good previous paediatrician advice) it was too close to the second and is known to be present in breast milk. I asked for azythromycin as although it is present in breast milk Bene has had it and was fine with it. He refused because it is known to be present in breast milk. He said he would prescribe it if Bene needed it but not for me with Bene as a consideration. So he was only prepared to give me one which might harm him, not one I know he is safe with. Does that explain it more clearly? I can’t see how it was a sensible doctor decision.
Thanks. Doesn’t seem great logic from the sense that he wouldn’t give it based on breastmilk excretion – all going to end up in the same place so why agreeable to give it one way but not another? Wonder if there was another consideration? Azithromycin does not figure in any of my guidelines but then they are hospital and not community based which may be the differenc – Presumably not good choice for serious infections. Doxycycline would be my go to in a person needing abs with an inability to have penicillin or erythromycin and short courses don’t seem to harm in breast feeding according to the infant drug sites. Having said that unless you are really septic or have grotty chest at best of times or are over 70yrs, then guidelines are to treat symptomatically but no need for antibiotics.
I feel the need to find primary care guidelines and see how they differ. Very interesting. Thankyou.
Hope you’re feeling better by now.
Their guidelines are not that different to mine :
Try and avoid antibiotics first off. If not then penicillins/ erythromycin/ clarithromycin / doxycycline. No azithromycin mentioned. Could understand him not breaking guidelines if he is not used to prescribing it as will be held responsible for adverse outcomes of doing something you have no prior experience of (& the suicide rate for doctors under stress of GMC investigation is high so to be avoided at all costs!) That’s why I manage the scary drugs i use rather than leave to GP as is not fair to ask them to take responsibility for drugs they are unfamiliar with but there does seem to be an alternative that could have been a compromise here and if uncertain there is always a microbiology consultant accessible for advice to other doctors – I find them very useful.
Definitely no mention of doxycycline at all. I would have remembered. The second gp spent a lot of time saying he had30 years experience. And tbh I don’t have a problem with them having guidelines or not going outside them. I have a problem with them refusing to acknowledge it might harm him, I have a problem with them not applying logic to the azythromycin request (as described) and I have a problem with a doctor saying ‘your call’ to someone just because he was pissed I had challenged back on the breastfeeding. He didn’t like that I had some understanding of the situation. It’s all very well if id accepted his guidelines and he was in the clear with the gmc on paper, but I’ve seen the effect the death of one of my sons had on a medic and I don’t want to see it again. Gmc clear or not, he insisted on prescribing a drug to follow the book that was not definitely safe for Bene and would have broken his heart and mine if it had gone wrong.
Well there’s a person who has never breastfed a toddler by the sound of it. They don’t take ‘no’ for an answer!
Oh FFS! Sorry to hear this – it would make my blood boil too. A friend had a similar response about BF from a doctor in a CHILDREN’s hospital – he said her son would be getting no nutritional benefit. I was only reading kellymom’s site about bf beyond one year last night! Goodness knows what that doctor would have said to my neighbour (an infant feeding specialist) who recently stopped bf her 6 yr old..
All of our OOH experiences have been pretty good…
What a kerfuffle. The lack of bfing knowledge in gps is frightening. My youngest only just fully weaned recently, just before he turned four. I think I would have squirted milk in that drs eye for being so ridiculously uninformed.
I have found this sort of think helpful when writing to the NHS: ‘if you fail to act upon the information which I have given you and either me or my child is hurt by your actions, either my self or my family acting on my behalf will seek legal advice and pursue appropriate recompense in addition to notifying the media which you and the NHS may not find is in your best interests.’
It seems more and more that the NHS believe your body belongs to them and you’re a naughty child who must do as they’re told. 🙁
Beyond insulting IMO. I reckon they were also on a power trip…putting you in your place because you KNEW something about the antibiotics and choice available instead of being average clueless Joe off the street. Good for you sticking to your guns. And on the ‘bright’ side at least you don’t have the crap Dr as your GP. Hope the ear has all cleared up and you are feeling better too.
ooh dear goodness really wish the NHS would get a grip
Hate Out of Hours GPs, I swear the last one I went to knew less about medicine than I do!!
I’m sorry to hear you had such a bad experience, and very surprised that any doctor would risk their personal view causing harm to a child, let alone two of them. I am a social worker (with older people) but would never dream of expressing my personal views. I’ve worked with people who have expressed things that I don’t necessarily agree with, but it’s none of my business. Have you got a local PALS service? I would advise formally complaining, and not letting it pass.
I hope you feel better soon anyway. Xxx
What awful situations! I don’t live far from Peterborough and City Hospital will be where I go to give birth, I can only hope I don’t need OOH before being admitted to the hospital. I hope you and Josie are both feeling much better soon x
Hmmm. I had my girls at pboro. For my boys I swapped to Hinchingbrooke; not a decision I’ve regretted. Good luck 🙂
I’ve either got Pboro or Leicester to choose from. Have heard positive things from friends who’ve delivered recently at Pboro and Leicester is a nightmare journey so it’s pretty much decision made for us!x
I think I’d chose pboro over Leicester. And my girls were long ago now 🙂
This makes me so cross! I would have felt like punching that first Dr . My son only stopped breastfeeding as he turned 4 so the idiot you came across would have loved me LOL I have generally found that get so funny when you know what you’re talking about. Hope you are all feeling better x
Just read the antibiotic bit again – passed me by first time as azithromycin isn’t something I use in any of my guidelines so am not familiar with it- but did he really say he would have given this to a proven erythromycin-allergic child? All the data says this is contraindicated in this scenario.
Well, bene’s reaction to erythromycin was a speedy red rash but we’ve not risked it again partly due to understandable terror on our part. But he’s had azythromycin safely 3 times since so it evidently safe for him. His first exposure to it was managed in hospital.
Oh Merry, I’m sorry. How awful all round. I hope you are all feeling better by now? Oh how I loathe incompetent doctors …. My 12 yo son has been battling a serious and chronic condition for a long while now; he’s been seen by endless specialists for the last 16 months and was only diagnosed within the last three … Anyway, last December i asked his pulmonary specialist if we might back him off the heavy duty inhaled steroids he was on because of the uncertainty over his health coupled with the serious side affects of that particular drug. She asked, “what side affects?” And I just stared. Then i said, “well, on the packages insert –” She cut me off “Oh i never read those,” she said. (!! Sorry, what?) And she went on, “the FDA [Federal Drug Agency here in US] approve all the medications we prescribe.”
Well. Right. But …..! There are still side affects! (With this drug, one is death) And contraindications for some patients! The medical student who was with her looked up the package insert on his phone and tried to show her but she pushed his hand aside. !!
In the end I did get him on to a lower dose but ….
Anyway! I breastfed my children until they weaned themselves. Heh. That doctor you saw would not have liked nor understood me. (T’was, you know, rather longer than 2 **smile** )
Big {{hugs}}