Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study.
OBJECTIVE
Communication experts have suggested that it is good practice to ask patients' directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians about using this strategy with their patients, focusing the interview on the problem of eliciting expectations of antibiotics as a possible treatment for upper respiratory tract infections.


METHODS
We conducted a qualitative study using semistructured interviews with 20 family physicians in South Wales, United Kingdom, and performing thematic analysis.


RESULTS
Family physicians assumed most patients or parents wanted antibiotics, as well as wanting to be "checked out" to make sure the illness was "nothing serious." Physicians said they did not ask direct questions about expectations, as that might lead to confrontation. They preferred to elicit expectations for antibiotics in an indirect manner, before performing a physical examination. The majority described reporting their findings of the examination as a "running commentary" so as to influence expectations and help avoid generating resistance to a soon-to-be-made-explicit plan not to prescribe antibiotics. The physicians used the running commentary to preserve and enhance the physician-patient relationship.


CONCLUSIONS
Real-world family physicians use indirect methods to explore expectations for treatment and, on the basis of their physical examination, build an argument for reassuring the patient or parent. In contrast to proposed models in the communication literature, interventions to promote appropriate antibiotic prescribing might include a focus on training in communication skills that (1) integrates these indirect methods as part of building collaborative physician-patient relationships and (2) uses the running commentary of examination findings to facilitate participation in clinical decisions.
Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom.
Mohammed
M
Mustafa
Fiona
F
Wood
Christopher C
CC
Butler
Glyn
G
Elwyn
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003142:Communication; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014852:Wales
D000900:Anti-Bacterial Agents
antibacterial agents; family practice; health communication; inappropriate prescribing; physician-patient relations; primary care; qualitative research; upper respiratory tract infections