Category Archives: Confessions of a Microbiologist

“Back pocket antibiotic prescriptions: Good or Bad?”

Whenever my children get taken to the GP for a suspected chest/ear/throat/sinus infection, more often than not we are given a “back pocket”/delayed antibiotic prescription to be used only if the child does not improve over the next couple of days.

Is this a good policy?

My analytical way of thinking deduces the following assertions from the decision to prescribe a “back pocket” antibiotic prescription.

  • The doctor has decided that based on the current clinical presentation, the patient doe not require an antibiotic immediately.
  • The patient/guardian now has the primary responsibility as to whether the antibiotic is actually given or not. Is this really a good thing?

Studies have shown that back pocket prescriptions are acted upon about half the time, maybe a bit less than that. Whether or not a back pocket policy reduces antibiotic prescribing depends entirely on what you are comparing it against. If you say that all these patients would otherwise have received an antibiotic straightaway, then of course you can demonstrate a reduction! (Lies, damned lies and statistics…)

So what seems like a good idea may in reality may not be so perfect after all.

Given that only a small minority of such infections ever really need an antibiotic I prefer an educational approach (check out this leaflet), along with advice to come back if not settling in a couple of days’ time for clinical reassessment.

I remain to be convinced that back pocket prescriptions are a truly effective means of antimicrobial stewardship. To me it is more a way of the GP showing that they are doing something for the patient, a bit of a halfway house as such. It may even give out the completely wrong message to the patient. i.e. “I am not interested in seeing you again.”

If we are really serious about antimicrobial stewardship, then I think we need to review the back pocket policy. I think antibiotic prescribing for minor infections needs much tighter regulation. I also think including the clinical indication for the antibiotic on the prescription should be mandatory.

So the antibiotic prescription in my back pocket hardly ever comes out, and my gut feeling is that it shouldn’t even be there in the first place…

Michael

Here is an article with a bit more detail on this debate.

“Face to face”

Sometimes your chair can be just too comfortable

It can be all too easy to sit in front of a computer all day, allowing yourself to be sucked in by a vortex of emails, playing to the tune of other people’s agendas, and from which it is difficult to escape as work fatigue sets in. We become hypnotised by the screen and frozen to our chairs.

Or if you are a scientist, you might feel compelled to sit all morning at the bench reading agar plates, without any hope of reprieve…

So one of my resolutions for 2018 is more face to face time. Less time in front of a screen and more time talking to people, building relationships, and breaking down barriers. By this I don’t mean more formal meetings, just more informal chats, and not necessarily about work!

Sure, there will always be periods where I need to be in front of a computer:- reading articles, reviewing or writing laboratory policy, checking emails, analysing data, etc. But I want to ensure that this is the minority of my working day, not the majority.

The same applies if you are working at a bench. If you have a mountain of culture plates to read, or samples to set up, then the risk of boredom and consequent errors is a genuine one. Make sure such work is punctuated by occasional wandering and chats to your colleagues. Discuss possible ways to make the laboratory process more efficient, or just talk about what you got up to at the weekend! And never, ever feel compelled to stay at your bench just because your boss is sitting in the office nearby. This is not school anymore!

Being an introvert, I am not a natural conversationalist, but this year I am going to force myself out of my comfort zone. Disagreements with colleagues, which are inevitable from time to time,  are so much easier to navigate through if you have a good working relationship with them.

To quote the often used cliche. “Nobody has ever said on their deathbed ‘I wish I had spent more time in the office/at the bench.‘”

But it’s absolutely true.

So in 2018 I will endeavour to seek more face to face time, assuming I can find somebody who is not busy sending emails or reading plates…

Michael

 

” The Juggling Microbiologist”

What a year 2017 has been!

First and foremost, a new addition to the family. I wasn’t expecting that at the start of the year! Even more unexpected was the fact she needed emergency heart surgery at two weeks of age. A stressful time for everyone, and it definitely put work in perspective . As you can see however, she is now thriving.


Baby Isobel

I also managed to travel to a few new countries:- Austria, Hungary and New Caledonia. Each one was interesting in their own way. It is great to have the opportunity to visit new places, and experience different cultures.

And on top of all that, a new job!

Never being one to turn down a challenge, I have recently accepted a part-time job at the national Public Health microbiology laboratory in New Zealand. This means I now have two jobs, one that is focused on diagnostic microbiology, the other on Public Health microbiology (surveillance, typing, etc.).

It is a good mix, but you are right, I am a complete sucker for punishment…!

However, the main upside to having two jobs is variety. I have worked solely as a diagnostic clinical microbiologist for 11 years now. Same place, same job, day after day, week after week, month after month. I was slowly but surely becoming institutionalised. Change was badly needed, and this new post has given me that change. The learning curve will be steep, and the dynamics and politics of my new workplace will need to be learnt over the forthcoming months. I am looking forward to building lots of new working relationships.

Change is good.

The main downside of having two part-time jobs is that they might be part-time on paper, but full-time in reality! I will need to be very careful not to fall into that trap. Over the years I have seen many “martyrs” do full-time jobs on part-time wages. I always promised myself that would never happen to me.

I will need strong resolve to keep that promise.

So now I am juggling two jobs and a family of eight! As a consequence I will need to be utterly ruthless with regards to time management. I am looking forward to the challenge nevertheless.  Thankfully I am still young(ish), and hopefully I will be able to cope.

Is it sustainable in the long term? Who knows?

What I do know is that nothing is forever…

I suspect 2018 will be an interesting and challenging year, and like 2017, will hopefully bring a surprise or two.

This year, I am just going to relax, keep myself mentally and physically healthy, and juggle the very best I can.

Happy New Year!

Michael