Themes, Subthemes, and Codes Describing Family Physicians’ Views and Experiences of the URTI Consultation
| Main Theme | Subthemes | Codes |
|---|---|---|
| Family physicians’ views about managing the URTI consultation: the challenge of the consultation | Prior physician expectation | Clinician assumption |
| Preset clinician intent not to prescribe | ||
| Recognition of evolving practice and patient culture | ||
| Loss of discrimination between treatment options because of swine influenza | ||
| Conflict within the consultation | Situations that raise potential for conflict | |
| Avoiding conflict | ||
| Negative impact of seeking patients’ views | ||
| Minimize potential for conflict | ||
| Delayed provision of prescription under pressure/insistence | ||
| Delayed provision of prescription to avoid confrontation | ||
| Prescribing to avoid complaints/confrontation | ||
| Patients’ high expectations for antibiotics | Explore reasoning when patient seeks antibiotics | |
| Challenge or modify antibiotic-seeking behavior | ||
| Patients’ beliefs about antibiotics | ||
| Delayed provision of a prescription under pressure/insistence | ||
| Inappropriate prescribing a source of dissatisfaction/poor practice/failure | ||
| Challenges | Patient/parent behavior with respect to social norms/culture/family | |
| Challenge with respect to parental anxiety | ||
| Challenge with respect to age | ||
| Challenge with respect to patients’ previous experiences | ||
| Delayed provision of prescription perceived as quicker | ||
| Delayed provision of prescription for social reasons | ||
| Prescribe according to symptom duration | ||
| Prescribe according to previous symptom progression | ||
| Prescribe in cases of chronic illness | ||
| Family physicians develop strategies to elicit and influence expectations of antibiotics: the solution to the challenging consultation | Thorough examination | Examination is good practice and part of physicians’ role |
| Examine to justify visit | ||
| Running commentary shares information | ||
| Careful word choice | Diagnosis spin: minimize mismatch | |
| Running commentary to reassure | ||
| Diagnosis spin: reassures, uses careful tone | ||
| Diagnosis spin: empathetic | ||
| Diagnosis spin: uses affirmation | ||
| Running commentary | Shares information | |
| Used with strategic intent | ||
| Reassures | ||
| Used to educate | ||
| Means to educate | URTI consultation is a means to educate | |
| Diagnosis spin: associate viruses with nonantibiotic management and bacteria with antibiotic management | ||
| Antibiotics: adverse effects | ||
| Antimicrobial resistance | ||
| Physician refers to evidence-based medicine and guidelines | ||
| Physician encourages autonomy | ||
| Challenge or modify antibiotic-seeking behavior | ||
| Physician explains distinguishing feature across consultation | ||
| Maintain/increase physician-patient relationship | Delayed provision of prescription for social reason | |
| Delayed provision of prescription for physician-patient relationship | ||
| Delayed provision of prescription for borderline cases | ||
| Nonantibiotic prescription justifies patient visit | ||
| Safety net | ||
| Family physicians influenced by relational, technical, and professional factors: the goal to be a good professional | Thorough examination (technical) | As for “thorough examination” above |
| Hedging (technical) | Diagnosis spin accounts for potential for symptom progression | |
| Careful word choice (relational) | As for “careful word choice” above | |
| Elicit expectations using open questions/ideas, concerns, expectations | ||
| Means to educate (educational) | As for “means to educate” above | |
| Organizational | Personal/practice pride in prescribing data | |
| Inappropriate prescribing as a source of dissatisfaction/poor practice/failure | ||
| Clinicians are to blame for antimicrobial resistance/pattern of patients’ behavior |
URTI = upper respiratory tract infection.