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awareness of these factors was valuable in negotiating Lucy’s management plan. Although symptoms of sore throat can resolve without complications, and simple analgesia is advocated, Lucy had expressed that she thought she needed antibiotics, and her high FeverPain score indicated a need for consideration to be given to antibiotic use. The questions that needed addressing were whether this would reduce the severity / duration of Lucy’s symptoms, what the likelihood was of complications developing and lastly, whether there were there any other interventions that would relieve her symptoms. Using a shared-decision framework, discussion centred on the issues of diagnostic uncertainties and the marginal benefits of antibiotics in the reduction of both duration and severity of symptoms compared with simple analgesia.
The outcome of the discussion was a decision for a delayed script for phenoxymethylpenicillin, 500mg four times a day, a treatment recommended as cheap, reliable safe and usually well tolerated (NICE, 2018 and Bird et al., 2014).
Safety netting as an important aspect of the consultation and management plan is recognised as effective strategy for reducing avoidable mortality and safely reducing re-attendance (Jones et al., 2019). Lucy’s consultation entailed discussion around diagnostic uncertainties, time course of the illness when to take the antibiotics if symptoms did not resolve, and advice as to when and how to seek help in the event of worsening symptoms.