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Comment by siquick | Hacker News Reader

Lived in Australia for over 10 years and can confirm that GPs here are, on the whole, pretty useless. Most appointments last under 2 minutes and end with a script, usually antibiotics of some kind.

I had covid recently and a woman at work who had identical symptoms but wasn’t testing positive went to the GP and was prescribed antibiotics.

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I thought the GPs were just fine but it's true that they do offer antibiotics almost every time you have a cold. In the US, you would demand them from your doctor and they would say no.

Whether it was placebo or not, it did usually seem to make me feel better.

> I thought the GPs were just fine but it's true that they do offer antibiotics almost every time you have a cold.

Those two sentences contradict each other; it is a very irresponsible thing to do. Also, yes, if every time you have a cold, you get antibiotics and they make you feel better, it is placebo.

> if every time you have a cold, you get antibiotics and they make you feel better, it is placebo.

Not necessarily. Azithromycin, a common antibiotic used for upper respiratory infections, has anti-inflammatory effects separate from it's antibacterial effects[1]. So it may make patients feel better even if they have a viral infection. Thus perpetuating the patient's belief that they "needed" antibiotics.

[1]: https://pubmed.ncbi.nlm.nih.gov/15590715/

An even simpler explanation is return to mean. They were going to get better in a few days anyway, with or without antibiotics. But if they keep getting antibiotics each time, they're always going to think that they helped. Confirmation bias comes in here too, why not.

What's even worse is that unnecessary use of antibiotics can affect someone's gut biome and leave them worse off for months, in some extreme cases years. I have had antibiotics only a couple of times in my life (for bleeding injuries) and I noticed the effect on my gut each time. To think that people create this problem when they don't have to is alarming. I hope for their sake their doctors _are_ prescribing them placebos so it's harmless ignorance.

I took 1000mg of amoxicillin twice a day for about 6 months. I was terrified that it would destroy my gut flora and I would contract cdiff but in the end I didn't notice any adverse effects. Many people take yogurt with antibiotics but I didn't do that nor take probiotics.

Walking out of the pharmacy with 8 boxes of antibiotics at a time was a fun experience. I can't remember but in Australia I think it was less than $5 a box without insurance.

> An even simpler explanation is return to mean. They were going to get better in a few days anyway, with or without antibiotics. But if they keep getting antibiotics each time, they're always going to think that they helped. Confirmation bias comes in here too, why not.

Yes there's the saying among doctors, for patients with a cold who want medication (e.g. antibiotics): "You can either wait and feel better in a week, or I give you medication and you feel better in 7 days."

Who goes to a GP for a cold? Your symptoms would have to be pretty severe to do that wouldn't they? And if so, maybe it's not just a cold.

Almost all workplaces I have worked in insisted on having a sick certificate even for a single day. Several times I was asked to come to work for a few hours even when quite visibly ill.

Wow, that's terrible. That would be nearly impossible for me to produce, because GPs around me are sometimes booked out a week in advance.

Gp visit is free. Often need doctor cert for work to take more than a day or two off.

This hasn't been the case for most GP's for a while now. Bulk billing is becoming quite rare if you're not a pensioner.

Mine still is shrug

Just counter this with a little more anecdata, I'm a regular GP visitor in Australia and have found them to be great. The only antibiotics I've been prescribed in the past decade were for a particularly persistent parasite infection.

Out of curiosity, what sort of parasite? I did not know there were parasitic infections that could be treated with antibiotics as opposed to an anti-parasitic drug like mebendazole.

Viral infections generally don't last past a certain amount of time, so when someone who is not immunocompromised clearly has an infection past a certain point, it is assumed to be bacterial.

It's also not unusual for someone to end up with a bacterial infection because their immune system is weakened from the viral infection.

Your coworker almost certainly didn't repeat everything the doctor said or did, nor should she have to; mind your own business. It's wild that you were not there, don't posses any medical training, but consider yourself more qualified...

That’s not true at all; you can’t generally distinguish viral infections from bacterial infections by the length of illness. [charitably, this is somewhat a useful rule of thumb for many cold like illnesses, but the GP knew how long they were sick…and Covid is a good example of something some people are very sick from for a long time.]

Why do you think any real expertise is required for a situation like this? It’s a simple reality that medicine, like any field, is brimming with practitioners who do not follow best practices and even many that are not good at their job. Doctors make terrible decisions all the time. I can give you numerous anecdotes in my life where doctors were dangerously wrong even when presented with very clear evidence.

I am a person with a history of pleuro pneumonia. Doctors holding out on antibiotics twice nearly took my life (not exagerating, this was said by doctors)

It's very hard for me to get antibiotics and at the same time I have a high chance of getting nasty bacterial infections with each cold. The last infection 2 years ago has caused me to have a permanent cough. Just wish antibiotics weren't so vilified, they actually serve a purpose. Why can't we reduce use in livestock first?

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