The Importance of Managing Patient Expectations

Hello, my name is Nick Francis, and I am a GP in South Wales with a research interest in use of antibiotics. This webinar is on managing patient expectations. Now, patient expectations are important, because they influence what we as prescribers do. Now you may not feel that you’re influenced much by what patients want, but there’s good evidence to show that patients who expect or want antibiotics are more likely to be prescribed them. And when you think about it, it’s not that surprising. We want to maintain good relationships with our patients, and to work with them rather than against them.

So unless we can be 100% confident that antibiotics won’t make the slightest bit of difference, it’s understandable that we might be influenced by what the patient wants. But what does the patient really want? Research shows that clinicians make assumptions about what patients want and overestimate the desire for antibiotics. And when a clinician perceives that a patient expects antibiotics, it’s an even bigger driver of antibiotic prescribing than actual patient expectations. So one of the key messages from this webinar is don’t assume that you know what your patient wants, particularly about antibiotics.

Surveys, interviews, focus groups have all shown that patients with respiratory tract infections want a good clinical assessment, they want to be given information about what’s wrong with them, to know how long it’s likely to last and what they can do to get better quickly. But the majority don’t have fixed ideas about the need for antibiotics. Indeed, patients are becoming increasingly worried about using antibiotics. A recent large primary care study of patients with lower respiratory tract infections found that two out of five patients prescribed antibiotics in primary care actually didn’t even start taking them.

Now clearly, there will be some patients who make strong requests or demands for antibiotics, usually because they’ve been trained by their past experience of being given antibiotics for self-limiting infections. And these patients, when they have strong demands, I usually start moving towards a discussion about backup or delayed prescribing. However, even patients who ask for antibiotics don’t necessarily want them. Some patients are not keen on taking antibiotics, but have been led to believe that they won’t get better without them, and these patients are often very happy to avoid antibiotics when they’ve been given a more evidence-based perspective.