Antibiotic prescription more likely if patient expects it

Doctors are more likely to prescribe antibiotics when they believe their patients have a high expectation of it, according to new research by the University.

The study, published by the journal Health Psychology, found that doctors are more likely to prescribe antibiotics in these cases even if they think the probability of bacterial infection is low and antibiotics would not be effective.

Numerous studies have shown that inappropriate and excessive antibiotic use remains one of the main causes of antibiotic resistance and is widely considered a major threat to global health.

“Much effort has been spent encouraging doctors to adhere to clinical guidelines when prescribing antibiotics. However, with few notable exceptions, these efforts rarely address the non-clinical factors, such as how to tackle patients’ expectations,” said the study’s lead author, Dr Miroslav Sirota, from the Department of Psychology.

Researchers conducted two separate experiments involving 436 doctors in the UK. In one experiment, GPs filled out a questionnaire that presented them with one of several different scenarios. All the scenarios involved a 15-year-old girl accompanied by her mother who is on her third day of symptoms of a typical ear infection, however is systematically well with no ear perforation or discharge. In one version, the mother insists that the doctor help the girl to recover quickly since she has to participate in an important swimming event in four days (high expectations condition). In another scenario, there is no upcoming swimming event as the girl has already finished her swimming season (low expectations condition).

Overall, physicians who read the scenario 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.

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

He added: “The findings were also somewhat reassuring as we thought that the effect of non-clinical factors might have been even more serious than we had imagined.

“Imagine, for example, that a GP rationalised her decision to prescribe the antibiotics by increasing the perceived probability of a bacterial infection. We did not find any evidence of that happening, which is good news, and has taught us something new about the ‘localised’ effect of expectations.”

The second experiment involved a story of an adult patient with ear infection symptoms who either had low or high expectations for antibiotics. In this case, 52 per cent of GPs prescribed antibiotics and were more likely to prescribe them if the patient expected antibiotics during the consultation. As in the previous experiment, there was no difference between the doctor’s reports of bacterial probability and antibiotics prescribing. In the third scenario, involving an adult patient with typical cold symptoms who had high expectations for antibiotics, only 12 per cent said they would prescribe them.