How doctors can reduce antibiotic demands from patients

New recommendations for reducing the number of patients demanding antibacterials for viral infections:

1.  Remove all of the educational signage that is currently in your waiting room. It doesn’t work (more evidence), probably because most posters are targeted at elementary school brains.  The average adult in the United States reads with the understanding of an 8th grader, so posters should be designed for that level, or above.  What you put in your waiting room really does matter, and you (the doctor) should dictate this, not your interior decorator or office manager, even though they might have strong opinions on the matter.  And be critical of all the glossy posters you can receive for free from health organizations — I’ve looked at hundreds, and the vast majority are simply awful. They should spend their money on something else.

2.  Consider replacing the above posters with the document below (it’s free!). Here’s the PDF version for printing: anti-infectives-poster.pdf.  Make the poster large. Place copies in the examination rooms, too. It introduces your waiting patients to the vocabulary you will use later.  It will prime their brains.

Types of anti-infective drugs

3.  After patient examination, how you deliver the diagnosis matters.  After you tell them that they have a viral infection (flu, cold, etc.), mention that one treatment option is an antiviral (Tamiflu, for example).  Saying “antiviral” is critical — it’s a word used in many television shows and movies so the public knows it. Mention why you think their infection is not bacterial. They came to office hoping to get antibacterials, so you know you have to bring it up.  If they mention “what about antibiotics?,” respond that antibacterials only work against bacteria, and point to the wall chart above.  I.e., use “antibacterial” not “antibiotic.” In the United States, 36% to 45% of adults believe that “antibiotics” are effective at treating viral infections (outside of the US, the number is higher).  Using the word, “antibacterial” avoids this problem, completely, since people understand what the word means just given its roots. Training yourself to stop using the word “antibiotics” will be hard, but it’s worth it — the word is a big source of the over-prescription problem.

The above is my recommendation, of course.  Everyone else on the planet insists on sticking with the word “antibiotics” and with patronizing, bloated signage that most likely is never read. My view is that these old strategies have not really been working, and it’s time to try something different. For more on how linguistic “levers” might reduce patient’s demands for antibacterials, see this paper (PDF).

My other posts on antibiotic abuse.

About Colin Purrington

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