6 steps to take when a patient insists on that antibiotic

In this issue of JFP, Wiskirchen and colleagues discuss the appropriate use of antibiotics in outpatient settings, providing stewardship advice for several conditions we frequently see in primary care practice.

One of the symptoms for which we most frequently battle requests for antibiotics is acute cough. Despite the fact that more than 90% of cases of acute cough illness (aka acute bronchitis) are caused by viruses, the prescribing rate for it in the United States remains about 70%.¹

Over the years, I’ve honed a “spiel” that I use with patients with acute cough illness to help keep my antibiotic prescribing to a minimum. It must be working; my prescribing rate is less than 20%. What follows are some of my catch phrases and techniques.

1. Acknowledge the patient’s misery. “Sounds like you have a really bad bug."

Patients may be less likely to ask for an antibiotic if you refer to acute bronchitis as a "chest cold."

2. Tell the patient what he or she doesn’t have. “Your lungs sound good, and your throat does not look too bad, so that means you don’t have strep throat or pneumonia. That’s good news.”

3. Explain what viruses are “making the rounds.” If you have surveillance data, that’s even better. “I have seen several other patients with symptoms just like yours this week.” Over 25 years ago, Jon Temte, an FP from Wisconsin, drove down prescribing rates for acute bronchitis below 20% in family medicine residencies by providing feedback to physicians and patients about the viruses circulating in their communities.²