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Chiropractic Research Review

Patient Satisfaction at the Expense of Wellness?

Despite well-established evidence that antibiotics do little to combat viral infections, prescriptions for managing sore throats continue to be written, and there are indications that annual antibiotic costs are on the rise.

An Australian study of 21 general practitioners and patients who had recently consulted for a sore throat or upper respiratory tract infection examined the rationale behind inappropriate antibiotic prescription.

Several startling observations emerged from this study, presented as follows:

* Doctors knew of the evidence supporting the ineffectiveness of antibiotics for treating sore throats, yet often prescribed to promote a positive relationship with patients.

* Most doctors found prescribing "against the evidence" uncomfortable and realized doing so increased workload.

* A third of the patients had clear expectations to receive antibiotics, although satisfaction was often related to receiving assurance, information and pain relief.

The authors draw some powerful conclusions: "Consulting strategies that make patient expectations explicit without damaging relationships might reduce unwanted antibiotics. Repeating evidence for the lack of effectiveness is unlikely to change doctors' prescribing, but information about risk to individual patients might. Emphasizing positive aspects of non-antibiotic treatment and lack of efficacy in general might be helpful."

Take Note: Some use studies such as this to wage war on the target group. Chiropractors should use these results to reflect upon how they make decisions and how decisions can be influenced by psychosocial and financial pressures. The conclusions drawn by the authors emphasize that DCs must take an active role in telling patients about antibiotic misuse, as it appears unlikely that MDs prescribing habits will change.

Butler CC, Rollnick S, Pill R, et al. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. British Medical Journal, Sept. 5, 1998:317(7159), pp637-47.

Chiropractic Research Review

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