Child/Adolescent Health

Doctor's comments during a child's physical exam can affect whether parents push for antibiotics

Positive, supportive comments made by the doctor during the physical examination of a child seen for a viral upper respiratory tract infection (URI) can markedly reduce the percentage of patients who receive an inappropriate antibiotic prescription, a new study suggests. Viruses, which do not respond to antibiotics, cause more than two-thirds of URIs, but URIs account for approximately 75 percent of children's antibiotic prescriptions.

The researchers report that parents who hear positive comments during their child's examination, such as "no problem," in contrast to comments suggesting that there is a "problem" to be concerned about, are less likely to question the doctor's plan not to use antibiotics to treat the URI. The researchers analyzed videotapes of 261 patient encounters for viral childhood URI involving 38 California pediatricians in 27 community practices. They found that comments during the physical exam occurred in 71 percent of these visits (61 percent with only "no problem" comments, 10 percent with at least one "problem" comment).

For patient encounters for viral URI, "problem" comments were associated with a 13 percent increase in parents' questioning of the subsequent no-antibiotic treatment plan compared with visits involving "no problem" comments or no comments during the examination. Statements ruling out the need for antibiotics were independently associated with a 24 percent boost in parents' questioning of the treatment plan. Patient visits in which the doctor made any "problem" comments resulted in 27 percent more inappropriate prescriptions of antibiotics than visits in which only "no problem" comments were made. The study was funded in part by the Agency for Healthcare Research and Quality (HS13299).

More details are in "Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings," by John Heritage, Ph.D., Marc N. Elliott, Ph.D., Tanya Stivers, Ph.D., and others in Patient Education and Counseling 81(1), pp. 119-125, 2010.

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