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> Would like to hear back what you do and what age groups you use them in and what practice setting you are in.
--> I practise in a major ED with around 30K paeds cases per annum and over 100K adult.
But we're in the UK.
So it's not that big an issue with having people present with cold symptoms and congestion, except with very young children. This is something people here know and have known for some time. They DO present, but not very often at all.
We also don't have the same issue you suggest with a difference between practise settings because our children EDs and our primary care are all under the same NHS and all work to the same principles on this.
If it does happen that we see such a patient then we see them. If they don't need treatment, then we don't prescribe it. Symptomatic relief for congestion is available over the counter at pharmacies and supermarkets and parents will be told to go there if they request such items. This is the same as we would do for an adult (an even rarer presentation to have an adult with a cold or congestion in the ED and will usually be re-directed out by triage nurse). At the pharmacy, the pharmacists can advise people on what symptomatic medication might do what for them.
People are free to buy stuff even if it does not work.
We do not actually have a single cough syrup in the ED, nor any decongestants. I am not aware of any UK ED which does have them or has had them since I came to the UK for the first time around 20 years ago. We do not issue prescriptions for outside pharmacies, so we could not give them this stuff even if we wanted to. We could never have got stuff like that onto the formulary in the ED as we would have been unable to prove a benefit/indication for it.
I cannot say whether they had it in NHS EDs in the 80s or before.
I have been aware for almost 20 years as well that such stuff IS available at or via USA EDs, but could never find a physician who'd admit that he/she thought they should be...
I think that it will not take long for people to stop asking for the stuff once they started getting told "we don't have it and don't prescribe it". I suspect the reason this has not become the norm in the USA is because such a principled stance would result in poorer "customer survey" scores, which initially would only affect places who did "right" and cause them to drop in score relatively to places which did what the customer asks. It's the usual difference again - whether we treat the child as a patient or as a customer. Or we could look at it as an issue with definitions/assumptions: The customer is always right; the patient isn't alwasy sick...
Hope this helps.
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