Table 2

Themes, Subthemes, and Codes Describing Family Physicians’ Views and Experiences of the URTI Consultation

Main ThemeSubthemesCodes
Family physicians’ views about managing the URTI consultation: the challenge of the consultationPrior physician expectationClinician 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 consultationSituations 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 antibioticsExplore 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
ChallengesPatient/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 consultationThorough examinationExamination is good practice and part of physicians’ role
Examine to justify visit
Running commentary shares information
Careful word choiceDiagnosis spin: minimize mismatch
Running commentary to reassure
Diagnosis spin: reassures, uses careful tone
Diagnosis spin: empathetic
Diagnosis spin: uses affirmation
Running commentaryShares information
Used with strategic intent
Used to educate
Means to educateURTI 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 relationshipDelayed 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 professionalThorough 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
OrganizationalPersonal/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.