These days, there are over-the-counter medications for just about everything. If you have a cold, you can get an OTC medication. If you have heartburn, you can get an OTC medication. If you have an upset stomach, pain, a cough, allergies, or a multitude of other complaints, you can find an OTC medication. Unfortunately, we assume just because these medications are sold in pharmacies or on shelves at grocery stores or discount stores that they are safe, but how safe are over-the-counter medications.

Most over the counter medications are considered safe, if they have been approved by the FDA, but this only means that they are safe for human consumption. It does not mean that they are safe for you, as an individual, and this is where most over-the-counter medications are not safe.

Few of us take the time to read the labels on OTC medications, past what is says about what symptoms or ailments it relieves and how much you should take. We fail to read the warnings. Those warnings will often state that if you have certain medical or physical conditions that you should not take the medication or you should consult your physician before taking the medication. They aren’t just printing that information on those labels for amusement or to fill space! They generally mean it, and you need to follow those instructions!

The same is true for the dosing instructions. These aren’t just doses that they pulled out of a hat. The drug has been tested, and these are the safe or effective amounts that are needed for your ailment, and to prevent over dosing on the over-the-counter medication. Failure to follow these dosing instructions, including the time to wait between doses, can be detrimental to your health, at the very least, and fatal in the worst cases.

As you can see, it is typically our own lack of judgment that causes an FDA approved over-the-counter medication to become unsafe. Read the entire label. Know what ingredients are in the medication. Know what the dosage is, what the potential side effects and risks are, what the serious side effects are, when to see your doctor about side effects, and any other information that is supplied. Ask your pharmacist or your doctor for an explanation of anything that you don’t understand, and if you are ever in doubt, simply don’t take the medication. Finally, when you take any medication, take the smallest dose that is possible for your condition.

One of the most common problems today associated with control of infection is the over prescribing of antibiotic drugs. Many infections that we are familiar with such as colds and flu are caused by viruses which cannot be treated by antibiotics. Only bacteria are susceptible to antibiotics. However it is often the case that patients expect antibiotic treatment and doctors may prescribe them as a precaution against a possible secondary infection. As a result we now see the development of super bugs or antibiotic resistant bacteria. But how does antibiotic therapy cause super bugs to evolve?

There are several mechanisms at play here the first one being Random Mutation. This is actually a completely normal process. In any bacterial growth a certain amount of mutation will occur. Sometimes a mutation will confer an advantage to a bacterial cell which causes it to be resistant to the effects of an antibiotic. In this situation the susceptible bacterial cells are killed by the antibiotic leaving the resistant cells free to replicate and form a new strain. This is a basic species survival mechanism leading to the rise of new resistant strains of bacteria.

Plasmids are another weapon in the bacteria’s arsenal against antibiotics. These are extra pieces of genetic material which exist independently within the bacterial cell. They are in a constant state of change, acquiring and losing genetic information. If the genetic information in a plasmid confers resistance to an antibiotic, it can replicate and be passed quickly from cell to cell. In this way antibiotic resistance can easily develop and spread within the colony.

A third mechanism which bacteria can avail of is the use of Transposons. These are even tinier pieces of DNA material. Transposons have often been called jumping genes. They can jump from a plasmid to a chromosome and vice versa. They can easily transfer resistant genes and pass this resistance on from cell to cell.

When we use antibiotics all of the above mechanisms come into play and combine to create the super bugs that we hear about from time to time. Of course it is absolutely necessary to use antibiotics to treat infection but using them when they are not strictly necessary actually contributes to the development of resistant super bug strains.

What is Article 14?

The Postgraduate Medical Education and Training Board (PMETB), which gained its full statutory powers in September 2005, regulate postgraduate education for doctors in the United Kingdom. One of its present responsibilities is to coordinate applications to the Specialist Register made by hospital doctors via Article 14, which is the process whereby hospital doctors who have not followed the conventional specialist training route but who have gained the equivalent experience apply for inclusion to the register to become eligible to work as a consultant in the NHS.

To apply or not to apply?

Most emphasis is placed on the applicant’s training, qualifications, and the experience they have gained in their last five years of practice. Together with this, the applicants are assessed on six different evaluation criteria based on the General Medical Council’s (GMC’s) Good Medical Practice guidelines. These are:

• Good clinical care
• Relationships with patients
• Maintaining good clinical practice
• Teaching, appraising, and assessing
• Working with colleagues
• Probity and health

The first thing we ask doctors approaching us for assistance who are deciding whether or not to apply via Article 14 is whether they have discussed their intentions with their current Medical Director and other referees. Discussing your intended application with your referees and other sources can establish whether you have gained enough experience to become a consultant. The Article 14 application process comprises four steps:

• Compiling and submitting your application
• Confirmation that your application contains all of the necessary evidence
• Completion of structured reports by referees
• Assessment and decision by royal college or faculty and the PMETB
• Compiling and submitting your article 14 application

The actual application you submit to the PMETB comprises three parts:

• A fully up-to-date CV in the format stipulated by PMETB
• Completed PMETB application form
• Supporting evidence

It is important to note that the assessment panel will only have your completed application form, CV, and supporting evidence together with the feedback from your referees to make their decision. It is therefore vital that your application is clear and easy to follow. The PMETB has come under criticism for the delay in processing Article 14 applications so it is vital that your application is as complete and ordered as possible to avoid any unnecessary delays.

One useful tool for doctors wishing to apply via Article 14 is the use of a 360? assessment. The aim of this is to gain feedback from the colleagues and patients who you work with based on the GMC guidelines that are used by the PMETB to assess your application. This form of assessment can be mediated by your hospital if the service is available, or by an external company.

When collating your evidence anything that you refer to in your CV-such as a management report or a guideline development proposal-must be included in your supporting evidence.

Common errors made by applicants

To avoid unnecessary delay in your application being assessed, avoid the most common mistakes:

• Supporting documents (for example, confirmation of post letters) not having been validated with an official stamp from the relevant hospital
• Copies of certificates such as degree, royal college membership, or development courses attended not having been validated by a person of good standing
• Insufficient or excessive evidence being included-the supporting evidence should not exceed one lever arch box file
• The responsibilities and experience gained not being clearly described separately for each post
• Any gaps in employment not being accounted for

What happens once I have submitted my application?

Firstly, the PMETB will confirm that you have provided all of the necessary evidence required. If this is not the case they will write to you requesting additional information. Once they have all of the evidence they require they will then request structured reports from your referees. When these are complete your application is assessed by the relevant royal college or faculty against the PMETB criteria for entry to the specialist register. The PMETB will then make a decision based on these recommendations, together with guidance from any other experts, as to whether you are deemed competent to enter the specialist register. If the outcome is negative the applicant does have the right to appeal to an independent panel.

Taking your application forward

You can gain support and advice about your PMETB application from a variety of sources, including your royal college about specialty specific issues; the PMETB help line (0800 028 0644 for UK callers; +44 020 7535 5830 for overseas callers); and from organisations such as Developmedica who can provide a comprehensive PMETB Article 14 service to help with the completion of your CV, application, and collating of supporting evidence.