Skip to main content

Table 3 Using ‘social tools’ to help address perceived patient expectations

From: Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

• Perceived that patients expect to leave ‘with something’ – use of prescriptions and leaflets

 I have a very simple rule… They’ve made the effort to come and see a doctor, give them a bit of advice, or even a prescription or a form for physio or something like that, it’s the key to not getting complaints. Everybody gets a prize, even if it’s just a bit of written paper. [GP, FG4]

 I like to print out a post-dated prescription because actually giving them something in their hand to go away with gives them a sense that something’s happening. [GP, FG6]

 …patients are used to have something to take away with them, so when they come they need something... whether it is a prescription... Sometimes what may help is on EMIS you’ve got patient information leaflets…[GP, FG7]

 They tend to like to leave with something and if it’s not antibiotics and not what they want, they seem to want to leave with some form of prescription be it an over the counter medicine or be it something else... I’m seeing more requests for things like nasal sprays and linctus… [GP, FG9]

• Perceived that patients want tests and numbers – use of POC tests

 It’s funny, the amount of times that you’re advised to treat the patient not the number, the patient will be much happier with the number than your clinical judgement. [GP, FG2]

 I could also use [POC-CRPT] on these frequent offenders who come in saying ‘I want antibiotics’… if you show them it’s not this and it’s not 100 and that convinces them in some ways psychologically not to get the antibiotic. [GP, FG8]

 A really good thing is to have a tool to demonstrate to patients why they don’t need antibiotics. I use my SATS probe quite a lot as a... it’s not really a tool but it helps me, I’ll kind of say ‘Well your oxygen saturations are very good.’ Which is why I’m very interested in testing CRP ‘cause I think that’s a really good evidence based tool, which if patients understand, are going to be more receptive and accepting of your decision not to give them antibiotics, if you can actually demonstrate numerically that there’s no reason to. [GP, FG6]

 …like urine samples, they come in for urine symptoms when you think ‘This is not’ – and then you dip it and say ‘Look, there’s none.’ But that’s cheap… [GP, FG6]

 If you got a printout, you can give them a copy, it’s a prize, they’ve had a test… They think tests are how we do medicine, and they’re not… ‘oh, I need a test, I need a scan’. [GP, FG4]

• Perceived that patients need ‘evidence’ – use of clinical scores

 I use the FeverPAIN to not give them antibiotics because it’s just – it’s helpful to be like ‘well the computer says you don’t need them!’ And sometimes that works [laughter] better than ‘the doctor says you don’t need them!’ …it does unfortunately bite me in the bottom sometimes when they come back again and say: ‘well what does your score say?’ And it comes out saying ‘you need a delayed prescription!’ So they go away with a delayed prescription when probably clinically I wouldn’t have given them anything at all. [GP, FG3]

 Sometimes what can help in sore throat is the Centor or the FeverPAIN, so you can actually show them the scoring criteria and say, ‘X, Y and Z, because you haven’t got any of those criteria, evidence shows us that it’s very unlikely that this is bacterial and this is in fact viral.’ [GP, FG7]