Uncomplicated sore throats usually resolve themselves after three to five days, even if they are accompanied by elevated temperature for a few days. Some patients want an antibiotic from the family doctor - in the hope that the disease will pass faster. But in most cases, the remedies do not help at all, because sore throats are mainly caused by viruses against which antibiotics do nothing. The agent may even harm the patient if, for example, it causes nausea. If he leaves the family practice with an antibiotic prescription, then he was over-supplied.
A new guideline of the German Society for General Medicine and Family Medicine (Degam) - a guideline for the best possible medical treatment - should help to curb such oversupply of general practitioners. She also addresses areas in which patients are underserved, so get no or only too late a therapy.
The authors of the guideline have compiled recommendations from published guidelines on certain diseases that address over- and undersupply. Out of hundreds of such recommendations, 26 were included in the current document. They are especially concerned with particularly common diseases or those in which those affected have a very strong suffering. It's all about treatments involving GPs. Twenty-one of the recommendations are intended to prevent over-provision, and five should draw attention to impending shortages.
Three examples:
1. Early detection of skin cancer and prostate cancer: Is it really useful that all people regularly check for skin cancer? According to Degam, the benefits of such a skin cancer screening have not been sufficiently proven. The guideline therefore advocates early detection in individual cases after a balanced discussion about the pros and cons.
Prostate cancer screening using PSA should not be actively offered to men. If patients ask themselves, they should be informed about the advantages and disadvantages as well as the skin cancer.
2. Fatigue: If a patient presents with so-called primary unexplained fatigue, a fatigue for which there is no known cause, the family doctor should clarify with suitable questions whether the person concerned has depression, an anxiety disorder or an unrecognized infection. Otherwise, it would be more likely to be undersupplied, as doctors overlook a depression.
3. Acute back pain: They affect a great many people, are often very painful - and unfortunately doctors can do little at first. Because with acute pain in the back diagnostic tests and imaging techniques such as X-rays are unnecessary if there is no suspicion of a serious disease as the cause. In the case of nonspecific low back pain, no analgesics, so-called glucocorticoids or topical anesthetics should be injected.
Presumably, some patients with back pain find it hard to accept that the doctor does not recommend further tests or treatments, but says that a painkiller, sufficient exercise and patience are now the only necessary medicine.
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In fact, even a seemingly harmless X-ray can cause damage to the back pain: For many people there are abnormalities to discover that have nothing to do with the pain. However, once they have been made visible, there is a pressure to treat them as well - with all the possible side effects and complications of the following medical therapy.
Likewise, the early detection of cancer, for example, in prostate cancer risks, because conspicuous values require further testing and because in some patients cancer is discovered, which is then treated - but never had problems during their lifetime.
Doctors can only prevent overuse if they explain to patients well what and what is against a therapy. "Of course, this means effort for the doctors," says Dagmar Lühmann from the University Hospital Hamburg-Eppendorf, which was involved in the preparation of the guideline. "Excessive care can only be avoided if patients do not simply go to the nearest doctor who prescribes treatment for them."
