Research Report 2007

Publications by writers and editors at Memorial University

There's a Lot of it About: Acute Respiratory Infections in Primary Care

By Dr. Graham Worrall

Book Cover: There's a Lot of it About: Acute Respiratory Infections in Primary Care

When coughing and sneezing prompt a patient to visit their doctor, what are the chances there is a cure?

Family physician and primary care researcher Dr. Graham Worrall has spent a great deal of time and research on this question, and his conclusions are laid out clearly in There's a Lot of It About - Acute Respiratory Infections in Primary Care, from Radcliffe Publishing.

Dr. Worrall's book covers the most common respiratory infections - the common cold, sore throat, ear infections, sinusitis, bronchitis and influenza. Because parents get worried by croup and bronchiolitis in their children, there are chapters on these illnesses too.

The overriding message that Dr. Worrall has for the family physician dealing with acute respiratory infections is (in his York accent) "Do Nowt."

"If you came in with symptoms of coughing and sneezing, I would examine you carefully and if it were a cold I would inform you it would resolve on its own."

Dr. Worrall said some people may accuse his of being a "therapeutic nihilist" because of his views, but they are based on audit studies of the prescribing habits of doctors.

Portrait of Dr. Graham Worrall

Dr. Graham Worrall

"I found that family doctors are still prescribing antibiotics more than the microbiology would indicate. This book is aimed at professionals - at every family doctor in the world as well as medical students, residents and nurses, particularly nurse practitioners. Too many antibiotics are prescribed for a group of infections which are mostly viral in origin. All this prescribing doesn't help people get better more quickly. It makes them think they are sicker than they really are, it causes lots of side effects, and it probably causes the development of resistant bacteria."

Dr. Worrall noted that for some acute respiratory infections, such as croup in children, there are effective medications. And he said that the influenza vaccination is very effective. "What I am hoping is that doctors will use more of the effective medications and less of the ineffective ones."

Dr. Worrall trained at the Royal Free Hospital, University of London, and did three years of general practitioner training in Lancaster. After 13 years in a two-person practice in a small English village he did a master's degree in clinical epidemiology and moved to Newfoundland to join the Discipline of Family Medicine.