Luppo Kuillman

Chapter 5 126 Appendix 1: Vignettes indicating Yielding to Pressure  Indicator  Vignette  Yielding to pressure  Coughing for three weeks, “I want antibiotics now!” (vignette 1)  You have been working as a physician assistant at a general practice in Northeast Groningen for several years and you are now a familiar face, even with patients. On a Friday afternoon at 4.50 pm just before the consultation hour has ended, Mr. Wolderman, a well-known tenor, reports to the desk and with a loud voice he wants an appointment immediately. He says that he has been suffering from a persistent dry cough for over 1 week and is demanding antibiotics just before the weekend. The medical history does not report alarm symptoms, the physical examination does not indicate an infection, there is no fever and the CRP rapid test shows <10 mg / L. In short, you have no indica- tion to prescribe antibiotics. The patient is incensed and still demands a cure in a verbally aggressive manner. You explain that in accordance with the guideline of the Nederlandse Huisartsen Genootschap M78, “Acute coughing” there is absolutely no indication to prescribe antibi- otics. Mr. Wolderman kindles in anger because he has a solo part in the Matthew Passion in the Oosterpoort in Groningen.