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Patient Interaction: Discussing Antibiotics

Nick shows an example patient consultation discussing why antibiotics may not be useful for the patient and explains self-help measures that will assi
As I said before, there are many different ways to elicit patient concerns and expectations. And I’m not trying to suggest that the approach shown in the video is the best or the right approach. It’s important for you to develop a way of communicating that you feel comfortable with, and don’t rely on assumptions about why the patient’s come to see you, or assume that the patient will only be satisfied if you prescribe antibiotics. Now then, let’s go back to Mrs. Jenkins and take a look at one way of discussing diagnosis and treatment. OK. So I’ve had a good listen to your lungs, and there’s a few sounds there, probably from phlegm in the airways.
But there’s no sound of infection in the lung tissue. [coughs] So that’s good news. That’s good. Your temperature is normal. The oxygen in your bloodstream is normal, and your pulse are all normal. So those are all good things, as well. So what this points to is that you’ve got an infection in your lungs, but it’s not a serious infection. It’s in the airways, in what we might call bronchitis. But there’s no evidence of any serious infection, actually, in the lung tissue itself. Now, as I say, it’s not a serious infection. It will get better. We were talking before about antibiotics. Unfortunately, antibiotics don’t tend to do anything much for this sort of infection.
They don’t really make it get better much quicker. Oh, really? On average, research shows maybe half a day better, get better half a day quicker. And that has to be balanced against the downsides of antibiotics. They often cause things like thrush, and diarrhoea, and rashes. And the more we use antibiotics, the more bacteria become resistant to them. I see. So I wouldn’t really recommend antibiotics for something like this. Oh, you wouldn’t?
Well, I suppose if it’s because if they’re not going to help, then I’m fine with that. So I think you’ll get better perfectly well without antibiotics. I can give you some information about the problem. [coughs] So it’s an information leaflet you should find helpful. So as we’ve said, this is what I think you’ve got, bronchitis. And as it says here, it can last up to three weeks. Oh, gosh. I know that sounds like a lot, doesn’t it? I think you’ll probably start feeling better much sooner than that. You know, you’re probably over the worst of it now, to be honest. You’ll probably start feeling better in yourself.
But that cough, that– a nagging cough [coughs] can just persist for a while, unfortunately. So I wouldn’t worry about it just because you’re still coughing. It can drag on, but it should be gradually getting better. This section goes through some of the things you can do to help yourself. Have you tried anything so far? Have you taken any medicines or anything? Well, I mean like paracetamol. OK. Is that helping at all? Yeah. Well, it helped with the cold and stuff, you know, pain. Yeah. I mean, I’m still coughing so it’s not– So paracetamol doesn’t really do anything much for coughing. It can be helpful if you’re having pain, if you’re aching, headaches, things like that.
It’s not going to do much for the cough. You might want to try some cough syrups. They’re probably not going to get rid of your cough altogether, but they might help a little bit. And I would suggest you see the pharmacist and talk about various sort of cough medicines that you can try. OK? OK. Yeah, I’ll give that a go. There’s a few other things here. It’s important to try and keep yourself healthy, try and get lots of rest, eat healthy. Sometimes people, when they’ve got an infection like this, they’re just about getting over it, and then they catch another infection. Oh, goodness– [coughs] So washing your hands and eating well is all helpful. OK.
Although antibiotics are unlikely to help you at the moment, if you develop a most serious infection, then they could be important. So this section here goes through the sort of things that you should watch out for, OK? So if you develop any of these symptoms, then I would like to see you back again. So have a look at that when you get home. So I can take that with me? Yeah. Take it with you, and have a look through. And if you’ve got any questions or concerns, then let us know. Oh, yes. I will do. Thank you. OK. Is that all right, then? Yeah. Any questions or– Yeah.
Well, I suppose I’m just going to have to put up with it then, aren’t I? I’m afraid so, yeah. As I say, hopefully you’ll be starting to feel better soon. And the cough medicine hopefully, will help. See the pharmacist. And if you’ve got any concerns, then come back and see me again. Yes– All right. OK. Thank you very much. Nice to see you. Bye, then. Bye. Bye-bye. Bye.
Where my assessment suggests that the potential benefits from antibiotics is marginal, I tend to be fairly directive and tell the patient that I don’t think they need antibiotics. If the picture is less clear, for example, someone with a sore throat and three or four Centre or FeverPAIN criteria, or someone with a cough who’s got risk factors but no significant chest findings, then I tend to explain the potential risks and benefits in a more neutral way and ask the patient what they think.
Discussing how long the illness is likely to last, what they can do to help themselves, and what should prompt them to come back can all help increase satisfaction, reduce the risk of unhelpful re-consultation, and provide a good safety net in case things do take a turn for the worse.

Nick shows an example patient consultation discussing why antibiotics may not be useful for the patient and explains self-help measures that will assist recovery.

The TARGET “Treating Your Infection” leaflet is used during the consultation. This leaflet is available as a downloadable attachment below.

This leaflet allows you to explain to the patient:

  • How long common infections should last

  • Self help measures

  • The disadvantages of taking antibiotics

  • When and how to collect a back up/delayed prescription

You can set up a computer prompt on your clinicial computer system to allow you and your colleagues to be reminded to use the leaflet. All the TARGET leaflets are already loaded onto the EMIS and SystmOne they just need activating.

To read more about the development of the Target leaflet and how useful it can be in practice please read this paper published in 2016.

*The leaflet shown is now updated and rebranded in line with the Keep Antibiotics Working campaign (in Patient interaction and Discussing Antibiotics)
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TARGET Antibiotics – Prescribing in Primary Care

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