Archive for August, 2009

When Patients Want Antibiotics They Don’t Need: Offer Explanations, not Prescriptions

August 31, 2009

AntibioticsNotForColds

A patient with an upper respiratory infection comes to see you.  After performing a history and physical, you determine the patient has a viral infection.  You are concerned the patient will insist on a prescription for antibiotics.  Below are the steps to handle this patient concern.
 
Show Empathy
 
Think about how sick you felt with a respiratory illness.  They can be a miserable experience.  Here is an example of a statement you can say to a patient, “I understand you are not feeling well.  I want to assure you that I want to help you.”
 
Explain Difference between Viruses and Bacteria
 
For patients, viruses and bacteria are all “bugs.”  They do not perceive a great deal of difference between these organisms.  We need to explain to them the difference and then discuss how antibiotics are effective for bacteria, but not viruses, such as the virus causing the common cold.
 
You can mention to patients, “Most adults, on average, get two to three colds a year; and children can have eight to twelve colds a year. Most colds last about one week. But it’s not unusual for symptoms to continue for as long as two to three weeks.”
 
Describe Dangers of Antibiotics
 
Side Effects. Mention how antibiotics can be have unpleasant side effects. Say, “I do not want to give you a drug that will not help and possibly make you feel even sicker.” Describe potential antibiotic side effects including: upset stomach, diarrhea, rashes, and (rarely) serious allergic reactions (even with antibiotics that they may have used safely in the past).
 
Resistance. In addition, explain how overuse use of antibiotics can result in resistance to them.  For example, you can say, “Using unnecessary antibiotics can cause some bacteria to become resistant to the antibiotic. This increases your chances of having bacterial infections later that can’t be treated by antibiotics. This is called ‘antibiotic resistance.’”
 
Potential Patient Issues
 
Concern over Green or Yellow Mucus. A patient may state they are having green or yellow mucus and fearful that means their illness is serious.  We need to combine empathy with our explanation. You can state, “I could understand your fear.  We used to think that green or yellow mucus indicated a bacterial infection. However, today, we know this is not true. A viral infection can cause green or yellow mucus.”
 
Previous (Unnecessary) Antibiotic Prescription. Explain to patients that if they were given antibiotics in the past for colds that antibiotics often get credit that your body’s own immune system really deserves. Review issues of antibiotic side effects and resistance.  Also, mention newer knowledge of antibiotics.
 
Emphasize the use of self-care measures (such as fluids) and nonprescription medications.
 
It is important to remember, patient satisfaction is generally linked to communicating effectively not writing prescriptions.
 
The CDC has an excellent brochure for patients, “Cold or Flu. Antibiotics Don’t Work for You.”  Here is the link:
http://www.cdc.gov/GetSmart/campaign-materials/print-materials/Brochure-general-color.pdf

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

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