Scripted consultation

Scripted consultations are being seen as a good way of delivering information to patients by non-experts. I suspect they are also a very good way of teaching the non-expert. They have the benefit of defining 'norms' for the non-expert, making them more confident in imparting information. Here's a draft scripted consultation draft for 'no antibiotic' consultation. Probably too long... Elicit information • What do you think is going on? (e.g. afraid it is pneumonia) • What did you want to have happen at this visit? Provide information • Your illness has the characteristics of a viral infection, so antibiotics will do nothing to help you recover, and they do not prevent complications. • We worry about using antibiotics when they are not definitely needed because : • Antibiotic use can result in the bacteria you always have in your body becoming resistant to antibiotics. Bacteria that cause disease can pick up this resistance, and this may make more serious infections (when antibiotics can be life saving) harder to treat • Resistant bacteria can spread in the community and this may put other people with life-threatening conditions at risk. • Antibiotics often cause unpleasant side effects, like diarrhoea and rashes • Some times these side effects can be very serious, like some allergic reactions. • The latest research suggests that antibiotics will kill off a lot of your friendly bugs that live in your guts, and some of these may never come back • We don’t really know what this means, but these bugs may keep us healthy in lots of ways so we need to try to look after them o They produce vitamins o They may prevent allergies o They may stop other intestinal disease, like coeliac disease o They may reduce the risk of some cancers o They may produce substances that keep our brains healthy o They may even help stop us getting fat • There is also new research that suggests antibiotics may affect the bits of our cells that produce energy. Again, we don’t know what this means to our patients, but it is another good reason to try to avoid antibiotics unless we are sure you really need them. Safety net • I have a handout here to help you manage your symptoms, and we can discuss warning signs that you might need to be reassessed. Summarise So, you understand that we won’t give you an antibiotic today? I don’t think it will help, but if you develop any of the concerning symptoms on the list we will have to reassess you. Do you have any questions?