Arriving at no: Patient pressure to prescribe antibiotics and physicians' responses

Area of Science:

• General Medicine
• Health Services Research
• Communication in Healthcare

Background:

• Antibiotic overuse for viral acute respiratory infections (ARIs) contributes significantly to antimicrobial resistance.
• A substantial proportion of adults with ARIs receive antibiotic prescriptions, despite the predominantly viral nature of these infections.

Purpose of the Study:

• To investigate the patient-physician communication dynamics influencing antibiotic prescribing for ARIs.
• To identify subtle patient communication strategies that promote antibiotic prescriptions.
• To explore physician communication techniques that can mitigate inappropriate antibiotic prescribing.

Main Methods:

• Analysis of 68 video-recorded primary care medical visits from US corpora (2003-2004 and 2015-2016).
• Qualitative examination of patient communication tactics, including priming, nudging, and resistance to non-antibiotic treatments.
• Assessment of physician communication strategies, such as expectation management and persuasion.

Main Results:

• Patients utilize subtle communication methods (priming, nudging, resistance) to influence physicians towards prescribing antibiotics.
• These patient communication strategies are effective in altering clinical prescribing behavior.
• Physicians can effectively counter patient pressure through foreshadowing non-antibiotic outcomes and employing persuasive communication during resistance.

Conclusions:

• Physician communication strategies are crucial in managing patient expectations and countering pressure for unnecessary antibiotics.
• Effective communication, encompassing both *how* and *when* it occurs, is vital for reducing inappropriate antibiotic prescribing for ARIs.
• Addressing the interplay between patient and physician communication is key to optimizing antibiotic stewardship.