Managing patient expectations

Antibiotic consumption varies between countries, but antibiotic prescriptions seem to be more or less stable in the EU, even despite recent flu epidemics, said Dr Attila Altiner, General Practitioner and Head of the Department of General Practice at Rostock University, Germany.

Patients with sore throat look for advice rather than antibiotics when visiting their doctor. A recent survey revealed that 90% of patients consult a doctor for an explanation of possible treatment, while 87% consult a doctor to determine how serious the problem is. However it is extremely important that a thorough explanation is given rather than the physician simply dismissing the problem as “it’s just a virus”. In order to convey a meaningful message physicians should focus discussions on the expected duration of symptoms, the natural course of the disease, and the very low risk that could it become dangerous.

There are three concepts that appear to help reduce unnecessary prescriptions in the GP office. The first is prescribing feedback. “This works almost as a form of peer pressure, as physicians observe that their peers are prescribing fewer antibiotics than themselves, instead they advise symptomatic relief and their patients are satisfied,” said Dr Altiner.

The second is point-of-care testing. Although point-of-care tests are not included in many guidelines, they can be very helpful but need to be used in combination with a thorough assessment of symptoms. However the third and most promising concept is to improve communication between the healthcare provider and the patient. “Shared decision making means the patient becomes a partner alongside the physician. The physician provides key information and offers a process of joint decision making to identify a decision that provides satisfaction for the doctor, pharmacist, and patient.”

Dr Altiner concluded that physicians and pharmacists need to educate their patients and each other. This communication process can be summarised into a very simple threestep approach. The first step is to address patients’ concerns, be sympathetic, and take their complaints seriously. The second is to be vigilant. Mostly these symptoms are harmless, but patients should be advised that if their symptoms continue to worsen they should return for a second visit. Thirdly, the physician should counsel on effective self-management and advise on evidence-based treatments that will help relieve the symptoms.