• Physician views of patient expectations

    Whenever I write about physician prescribing behaviors, especially in preference sensitive areas, people complain that it’s not the doc’s fault; patients expect or demand certain drugs. Whenever I see that argument, I think of this study: “The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior.”

    CONTEXT: Despite growing concern over the escalating antimicrobial resistance problem, physicians continue to inappropriately prescribe. It has been suggested that a major determinant of pediatrician antimicrobial prescribing behavior is the parental expectation that a prescription will be provided.

    OBJECTIVES: To explore the extent to which parental previsit expectations and physician perceptions of those expectations are associated with inappropriate antimicrobial prescribing; and to explore the relationship between fulfillment of expectations and parental visit-specific satisfaction.

    DESIGN: Previsit and postvisit survey of parents and postvisit survey of physicians.

    SETTING: Two private pediatric practices, one community based and one university based.

    PARTICIPANTS: Ten physicians (response rate = 77%), and a consecutive sample of 306 eligible parents (response rate = 86%) who were attending sick visits for their children between October 1996 and March 1997. Parents were screened for eligibility in the waiting rooms of the two practices and were invited to participate if they spoke and read English and their child was 2 to 10 years old, had a presenting complaint of ear pain, throat pain, cough, or congestion, was off antimicrobial therapy for the past 2 weeks, and was seeing one of the participating physicians.

    MAIN OUTCOME MEASURES: Antimicrobial prescribing decision, probability of assigning a bacterial diagnosis, and parental visit-specific satisfaction.

    Basically, this was a study looking at parents’ expectations for antibiotics for their child’s cold symptoms versus what the physicians thought their expectation was. It also looked at whether antibiotics were prescribed. The results were surprising.

    The only significant predictor of an antibiotic prescription was the physicians’ perceptions of parental expectations for getting a prescription. When the physicians thought the parent expected a prescription, they wrote one 62% of the time. If they didn’t think parents wanted one, they only wrote a prescription 7% of the time. The kicker, though, was that physician prescribing behavior was not associated with what parents actually expected. Physicians often misread what patients wanted.

    Additionally the only significant predictor of parental satisfaction was a failure to communicate well. If a doctor didn’t prescribe antibiotics that a parent expected, that didn’t affect satisfaction.

    We’re so quick to blame patients, but we often don’t understand them. It’s us a lot of the time. Moreover, they’re not upset with us when they don’t get the drug; they’re upset with us when we don’t clearly explain what’s going on.

    Here’s a similar study. Here’s another. And another. And another.

    @aaronecarroll

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    • This tracks with my experience. I’ve taken kids to the doctor with bad colds and been told (apologetically) they don’t need anti-biotics. I didn’t expect anti-biotics, I just wanted a doctor to tell me what the right thing to do, if it was more watch and wait, that was fine.

      But, if they did need anti-biotics, I didn’t want to get them later than necessary.