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Research ArticleOriginal ResearchA

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

Mohammed Mustafa, Fiona Wood, Christopher C. Butler and Glyn Elwyn
The Annals of Family Medicine January 2014, 12 (1) 29-36; DOI: https://doi.org/10.1370/afm.1583
Mohammed Mustafa
1Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom
BSc Hons, MBChB, MRCGP, MSc
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  • For correspondence: mustafamh@cardiff.ac.uk
Fiona Wood
1Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom
MSc, PhD
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Christopher C. Butler
1Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, United Kingdom
MBChB DCH, FRCGP, CCH, MD, FFPH
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Glyn Elwyn
2Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire
MBChB, MSc, FRCGP, PhD
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  • Also a question of diagnostic uncertainty
    Hasse Melbye
    Published on: 30 January 2014
  • Relationship-centered Care
    John G. Scott
    Published on: 28 January 2014
  • Published on: (30 January 2014)
    Page navigation anchor for Also a question of diagnostic uncertainty
    Also a question of diagnostic uncertainty
    • Hasse Melbye, Professor

    This paper by Mustafa and coauthors gives a good picture of how GPs handle URTIs in real life. Already early in the consultation the GP will usually become quite certain that antibiotics are not needed, and prepare herself or himself for a discussion with the patient, who they expect usually wants antibiotics. However, the GP is usually not 100% certain whether a course of antibiotics is needed or not, and it will be important...

    Show More

    This paper by Mustafa and coauthors gives a good picture of how GPs handle URTIs in real life. Already early in the consultation the GP will usually become quite certain that antibiotics are not needed, and prepare herself or himself for a discussion with the patient, who they expect usually wants antibiotics. However, the GP is usually not 100% certain whether a course of antibiotics is needed or not, and it will be important to get information from both history and physical examination to increase the level of certainty. This implies a somewhat awaiting and humble attitude in the consultation, that patients appreciate. I see no benefit of discussing with the patient whether antibiotics should be prescribed or not before the physical examination has been finished, unless the patient brings it up. In any case the discussion should not lead to a conclusion at this stage. Regardless, GPs in this paper wanted to elicit the patient's expectation regarding antibiotics before the physical examination. Doing this they will be able to manipulate the significance of physical findings in the running communication with the patient, when antibiotics are expected but not found necessary. This is a somewhat sad consequence of the pressure the GPs expect from their patients.

    Isn't it a question of diagnostic uncertainty? If the GPs could be more certain that a course of antibiotics is not needed, would it not be possible to be more straightforward and relaxed? Scandinavian GPs base their decision on antibiotic prescribing on the C-reactive protein test, when in doubt.(1) Maybe that's why they are less concerned about the patients' expectations? Whereas Welsh GPs in the GRACE study perceived that 55% of the patients with acute cough expected antibiotics, the corresponding figures for GPs from Norway and Sweden were 16%-18%.(1)

    References

    1. Jakobsen KA, Melbye H, Kelly MJ et al. Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care. Scand J Prim Health Care 2010;28(4):229-236.

    Competing interests: None declared

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    Competing Interests: None declared.
  • Published on: (28 January 2014)
    Page navigation anchor for Relationship-centered Care
    Relationship-centered Care
    • John G. Scott, Family Physician

    Mustafa and his fellow authors have provided a fascinating look into the minds of generalist physicians as they describe strategies to provide appropriate care for patients with URTIs while avoiding power struggles with patients over expectations for antibiotics. I'm sure that most generalist physicians recognize the use of ongoing commentary during the physical examination to shape patients' expectations of the treatme...

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    Mustafa and his fellow authors have provided a fascinating look into the minds of generalist physicians as they describe strategies to provide appropriate care for patients with URTIs while avoiding power struggles with patients over expectations for antibiotics. I'm sure that most generalist physicians recognize the use of ongoing commentary during the physical examination to shape patients' expectations of the treatment that they will receive. Patients, of course do the same thing as some of the subjects pointed out in the quotes from the interviews. This "dance" of communication and collaboration is the essence of relationship-centered care, and the subjects of this study clearly found ways to provide that kind of care while still limiting antibiotic use appropriately.

    The best measure of the success of qualitative analysis is a sense of recognition by the reader that the findings resonate with his/her experience. The findings of this study elicit that sense of recognition in me, and I expect will do so for many other readers. The authors are to be congratulated for their excellent qualitative data collection and their insightful analysis. This study changes the conversation about appropriate use of antibiotics by emphasizing the importance of good clinician-patient relationships as a prerequisite to providing guideline appropriate care.

    Competing interests: ?? None declared

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 12 (1)
The Annals of Family Medicine: 12 (1)
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Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study
Mohammed Mustafa, Fiona Wood, Christopher C. Butler, Glyn Elwyn
The Annals of Family Medicine Jan 2014, 12 (1) 29-36; DOI: 10.1370/afm.1583

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Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study
Mohammed Mustafa, Fiona Wood, Christopher C. Butler, Glyn Elwyn
The Annals of Family Medicine Jan 2014, 12 (1) 29-36; DOI: 10.1370/afm.1583
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Subjects

  • Domains of illness & health:
    • Acute illness
  • Methods:
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  • Core values of primary care:
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Keywords

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  • qualitative research
  • inappropriate prescribing
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  • upper respiratory tract infections

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