Table 8 Interpretation and value of the microbiology stool report by GPs

Interpretation by GPs of a negative stool microbiology report

GP14 For me a negative report would be something that had, you know, no culture positive result or no other abnormalities in the report, like ova’s or cysts or whatever.”

GP7 “ Well I’m assuming a negative report means to me a result where they haven’t found any of what they were looking for, any significant, if you're asking for rotavirus, they haven’t found that or they haven’t found any bacterial infections or they haven’t found any ova, cysts or parasites. So they haven’t found a specific infection there.”

GP8 “A negative report means they haven’t grown anything, it doesn’t always mean there’s nothing there. Parasites, because you’ve got to wait for them too, … so it’s not 100%.”

GP9 “That it’s not shown a specific sort of pathogenic bacteria,.... it’s not saying there isn’t a viral gastroenteritis; it’s … about the more significant ones that I need to act on. It’s not saying they’re not infected diarrhoea.”

Value and Influence of the microbiology report on management of diarrhoea

GP6 “Well, quite strongly. If say they’ve got something like campylobacter and you ring up and they say they’ve still got bad diarrhoea, then it was a good indication to give them some treatment”

GP1 “It’s very useful. You know, if you’ve got, you know, to make the diagnosis, differentiate between say an infection or inflammatory bowel disease.”

GP19 “Yeah, I mean they give negatives as well as positives. So it’s useful to be able to tell people they don’t have X, Y or Z, as well as if they have got a positive result. Yeah I mean I think they give all the information I need. Plus we have a very helpful microbiology department locally. So I guess if there was something or I was unsure about I would phone one of the consultants up at the hospital and just take some advice.”

GP11 “It does and if anything come out of it there’s usually a piece of helpful advice as well about the significance of what it is or insignificance sometimes or whether to discuss with somebody else.”

GP3 “Well, I don’t have any negative views about them. You know, they give all the information we need.”

Negative opinions about reports

GP10 “Well it’s (the report) very basic. I mean I’ve got one in front of me, it’s got final report, appearance, Bristol Type 1, and I can’t remember the types. I know Bristol Type 1 goes to probably one to six or something and its different stools. And then it’s got microscopy and that’s blank … and then it’s got culture and … it just says salmonella, shigella not isolated, campylobacter, E. coli 0157 not isolated – that’s it.

GP14 “I think our positive pick up rate’s very low, and if we do generally pick something up then… their illness is often resolved. So they’re not necessarily that helpful.”

Antibiotic treatment reported by GPs in cases of diarrhoea

GP12 “Well I suppose if I had a fairly, if clinically I really felt that someone possibly had salmonella or campylobacter, clinically, then I might treat and get them to do samples and then review it. But that’s so unusual. My general, my default position is not to do anything until I know what I’m dealing with.”

GP13 “In two situations, one would be a positive result from the lab and the second would be bloody diarrhoea having travelled abroad, which case I’d give them erythromycin. .... I’d expect them to provide a stool specimen and then start the antibiotics whilst waiting the result, yeah.”

GP18 “Well I hope I’ve got that information. I don’t particularly say to the patient, I suppose I ought to in case they’ve got antibiotics from somewhere else, but I generally, I would make an, you know, I would look at their medication and look at what they’d had recently certainly. So I would take it into account. But I don’t suppose I ask specifically have you been anywhere else and got antibiotics.”

GP19 “If it’s our patients I would probably be aware of that anyway. So I’m not sure I’d necessarily ask; I would look on their notes and see if they were on antibiotics or has recently had a course.”

GP7 “Well I think, as I say, you often have to make a decision about whether to treat with antibiotics at the time you’ve decided that you’ll obtain a sample. Occasionally if it’s very mild, you’ll hold off treating until you’ve got the result back, but sometimes those symptoms are quite [severe] so that you’ve already made a decision to treat with antibiotics, and so you’re using the sample then just to confirm the course of action that you’ve taken three days before, but it’s still useful just to confirm you have treated them correctly, and then you can take the resolution symptoms to confirm that that infection has cleared.”