Understanding the culture of prescribing: perceptions of antibiotics

Key Messages

Although Welsh doctors know that antibiotics are an ineffective treatment for sore throats, they are sometimes reluctant to jeopardize relationships with patients over this issue.

A paternalistic approach to prescribing, that excludes the patient from the decision-making process, can increase inexpedient prescribing of antibiotics.

Shared decision-making may reduce inexpedient prescribing of antibiotics by enabling patients to make better informed decisions.

The issue

Antimicrobial resistance (AMR) is a global public health challenge, which has been accelerated by the inexpedient prescribing of antibiotics worldwide. AMR threatens the effective prevention and treatment of infections caused by bacteria, parasites, viruses and fungi and is a serious threat that requires action across all levels.

A lack of explicitness between doctor and patient could explain in part why some patients receive unwanted antibiotics and why others demand them. Patients often do not have enough information about the dangers of over-using antibiotics and physicians sometimes fail to explain the lack of effectiveness of antibiotics against viruses which could explain why so many patients expect them.

Cultural context

The cultural reasons as to why antibiotics are inexpediently prescribed are relevant to clinicians and policymakers because of the clinical and economic toll it has in relation to excessive use, preventable side effects, and the increasing prevalence of resistant organisms.

Doctors in the study explained how maintaining a strong relationship with their patients was the most important factor to them. If they thought patients expected antibiotics they were more inclined to prescribe them, irrespective of their effectiveness. Patients in the study had learned to associate recovery with antibiotics and so expected them for even minor ailments.

The historically paternalistic approach in medicine, whereby a doctor decides what is best for the patient, has led to a lack of openness between doctor and patients. A more open approach, with a shared decision-making process, is needed. This involves clinicians and patients sharing the best available evidence about a particular treatment, thereby supporting the patient to consider what option is best for them. The patient is placed at the centre and empowered to make better informed decisions.

Policy implications

Clinicians should be trained in shared decision-making in order to bridge the gap between patients and doctors in the hopes of reducing inexpedient prescribing of antibiotics. Shared decision-making entails a process of deliberation which explores and respects ‘what matters most’ to patients as individuals. By introducing choice, describing options and helping patients explore preferences, doctors can help patients making the most sensible decisions.

Links to further reading

  1. http://www.bmj.com/content/317/7159/637
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445676