Prescription of antibiotics by doctors are more when patient's expectations are high

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Prescription of antibiotics by doctors are more when patient's expectations are high

Increased and unmanageable use of antibiotics is a major cause of antibiotic resistance and it poses a major health threat across the globe. According to a study published by American Psychological Association in Washington, physicians are more likely to prescribe antibiotics when they believe there is a high expectation of it from their patients, even if they think the probability of bacterial infection is low and antibiotics would not be effective.  The present study is published in the journal Health Psychology. This study had two experiments conducted on 436 physicians in the United Kingdom to check the dose of antibiotics prescribed by doctors.

 In the first experiment, a questionnaire was filled by practicing family physicians (50% male) from around the UK presented along with several different experimental episodes. All the experimental episodes include a 15-year-old girl suffering from a typical ear infection and she was also accompanied by her mother. The patient was on her third day of symptoms of a typical ear infection with fever, ear pain and reduced hearing, but there was no ear perforation or discharge. In this study, two expectations were involved. In one version, the mother demanded from the doctor to help the girl in recovering quickly so that she can participate in an important swim meet in four days (high expectations condition). Another version did not demand a quick recovery. As there was no upcoming swim meet because the girl had already finished her swimming season (low expectations condition). According to above expectations, the physicians examined the probability of a bacterial infection and then they conveyed their desire for antibody prescription on a scale of zero to 10. Ear infections could be either bacterial (which may respond to antibiotics) or viral (which didn’t respond to antibiotic) and physicians could safely withhold or delay antibiotics unless the child was systematically unwell, had perforation and/or discharge in the ear canal, or if the symptoms had persisted for four days or more, in accordance with the UK guidelines, which is in line with the US and Canadian guidelines. An order of the questions was manipulated and presented before each participant to receive the bacterial probability question first and then the question on antibody prescription and others vice versa. Overall, despite the order of the questions, physicians who read the vignette where the mother had higher expectations for antibiotics prescribed them, even though they were no more likely than physicians in the low expectations group to think the infection was bacterial.

The second experiment episode included an adult patient with ear infection symptoms who either had low or high expectations for antibiotics similar to first experimental episode. In this scenario, about 52% of physicians prescribed antibiotics, and more likely if patients expected the same. There was no distinction between the doctor’s reports of bacterial probability and antibiotics prescription as described in the previous experiment. Another experimental episode was carried out with the adult patient who is suffering from typical cold and expected to had high expectations for antibiotics. Only 12 % of physicians prescribed antibiotics in the above case.

Sirota stressed that “We do not intend our study to criticize physicians and how they prescribe antibiotics. Rather, we want to point out that the over prescribing of antibiotics is a serious systemic issue and we should all work together, from patients having more realistic expectations about antibiotic effectiveness to physicians managing patients’ expectations when contradicting clinical guidelines to tackle its multiple facets”.


American Psychological Association

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The original title of the article:

Doctors prescribe more antibiotics when expectations are high, study says


Miroslav Sirota et al.

Exploratory, Antibiotics, Resistance, Prescription, Questionnaire, Effective
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