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Arriving at no: Patient pressure to prescribe antibiotics and physicians’ responses

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  • Stivers, Tanya
  • Timmermans, Stefan

Abstract

While the vast majority of Acute Respiratory Infections (ARIs) are viral, between a quarter and a third of adults presenting with ARIs are given an antibiotic, making antibiotic prescribing for ARIs a major contributor to the inappropriate prescribing problem. We argue that inappropriate prescribing persists because of the interplay between physicians and patients in the medical visit. Relying on a convenience sample of 68 video recordings of primary care medical visits drawn from corpora collected in 2003–2004 and 2015–2016 in the US, we show that although few patients are “demanding” or “requesting” antibiotics, many convey subtle forms of pressure through priming physicians for a bacterial diagnosis in their problem presentations; nudging towards a bacterial diagnosis during information gathering; and resisting non-antibiotic recommendations during the counseling phase. We find that patient priming, nudging, and resisting are effective strategies to influence clinical prescribing behavior. However, we also identify two ways that physicians can counter patient pressure by working to manage patient expectations through foreshadowing a non-antibiotic outcome and using persuasion when confronted with resistance. These, we show, are effective means of countering patient pressure. We argue for the dual importance of how physicians communicate and when they communicate.

Suggested Citation

  • Stivers, Tanya & Timmermans, Stefan, 2021. "Arriving at no: Patient pressure to prescribe antibiotics and physicians’ responses," Social Science & Medicine, Elsevier, vol. 290(C).
  • Handle: RePEc:eee:socmed:v:290:y:2021:i:c:s0277953621003397
    DOI: 10.1016/j.socscimed.2021.114007
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    References listed on IDEAS

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    1. Heritage, John & Stivers, Tanya, 1999. "Online commentary in acute medical visits: a method of shaping patient expectations," Social Science & Medicine, Elsevier, vol. 49(11), pages 1501-1517, December.
    2. Stivers, Tanya, 2005. "Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance," Social Science & Medicine, Elsevier, vol. 60(5), pages 949-964, March.
    3. Wang, Nan Christine & Liu, Yuetong, 2021. "Going shopping or consulting in medical visits: Caregivers’ roles in pediatric antibiotic prescribing in China," Social Science & Medicine, Elsevier, vol. 290(C).
    4. Kushida, Shuya & Kawashima, Michie & Abe, Tetsuya, 2021. "Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital," Social Science & Medicine, Elsevier, vol. 290(C).
    5. Stivers, Tanya, 2002. "Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters," Social Science & Medicine, Elsevier, vol. 54(7), pages 1111-1130, April.
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    Cited by:

    1. Wei, Wan, 2024. "Beyond the patient-doctor dyad: Examining “other” patient engagement in Traditional Chinese Medicine consultations," Social Science & Medicine, Elsevier, vol. 340(C).

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