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December 2017

Peppa Pig may encourage inappropriate use of primary care services

The BMJ is famous for – among other things – its light-hearted Christmas issue, which carries a selection of amusing papers and articles, which nonetheless are ‘proper’ scientific studies and subject to the journal’s usual rigorous peer review before acceptance. Here is one of the best of this year’s bunch

Exposure to the children’s television series Peppa Pig may be contributing to unrealistic expectations of primary care and encouraging inappropriate use of services, suggests a doctor in the Christmas issue of The BMJ.

Dr Catherine Bell, a general practitioner based in Sheffield, has often wondered why some patients immediately attempt to consult their GP about minor ailments of short duration. As the mother of a toddler and frequent viewer of Peppa Pig, she thinks she might have discovered the answer.

Peppa Pig centres around a young pig, Peppa, her family (brother George, Mummy Pig, Daddy Pig), and animal friends and members of the community.

Dr Brown Bear, a single handed GP with whom the Pig family is registered, appears to provide his patients with an excellent service - prompt and direct telephone access, continuity of care, extended hours, and a low threshold for home visits.

So Dr Bell decided to analyse three case studies and consider the potential impact Dr Brown Bear’s actions could have on patient behaviour.

Usual advice for uncomplicated self-limiting viral illnesses, such as coughs and colds, is to not see your GP, but to rest at home and drink plenty of fluids to avoid dehydration.

In case 1, Dr Brown Bear makes an urgent home visit to a 3 year old piglet with a facial rash. He reassures the parents it is “nothing serious” and offers a dose of medicine, but says the rash is likely to clear up quickly regardless.

This case questions whether Dr Brown Bear is an unscrupulous private practitioner for conducting an arguably clinically inappropriate home visit, says Bell. “It is also an example of unnecessary prescribing for a viral illness, and encourages patients to attempt to access their GP inappropriately.”

In case 2, Dr Brown Bear makes another urgent home visit to an 18 month old piglet with cold symptoms. After examining the throat, he diagnoses an upper respiratory tract infection and advises bed rest and warm milk.

Despite again opting to make a clinically inappropriate urgent home visit, Dr Brown Bear’s management “was at least clinically appropriate on this occasion, and his advice might encourage the family to self manage similar illnesses in future,” writes Bell.

In the final case, Dr Brown Bear makes an emergency visit to the playgroup after a 3 year old pony coughs three times. After examining the patient, he administers a dose of medicine immediately and warns that the cough is potentially transmissible. When the rest of the playgroup attendees and their parents develop symptoms, they are all given a dose of an unspecified pink medicine.

And when Dr Brown Bear also develops symptoms, his patients attend the surgery to administer his dose of medicine, and to sing to him.

By now Dr Brown Bear displays signs of “burnout,” suggests Bell. “His disregard for confidentiality, parental consent, record keeping, and his self prescribing indicate that the burden of demand from his patient population is affecting his health. He is no longer able to offer the level of service his patients have come to expect.”

Given that Peppa Pig is broadcast and encountered by parents in more than 180 countries worldwide, the influence of his portrayal of the work of primary care physicians is likely to be significant, points out Bell.

While Peppa Pig conveys many positive public health messages, such as encouraging healthy eating, exercise, and road safety, Bell suspects that “exposure to Peppa Pig and its portrayal of general practice raises patient expectation and encourages inappropriate use of primary care services.” Further study is needed to confirm this, she adds.

Bell C, Does Peppa Pig encourage inappropriate use of primary care resources. BMJ 2017;359:j5397