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Rita Mangione-Smith, MD, MPH; Elizabeth A. McGlynn, PhD; Marc N. Elliott, PhD; Laurie McDonald, MS; Carol E. Franz, PhD; Richard L. Kravitz, MD, MSPH

Arch Pediatr Adolesc Med. 2001;155:800-806.

Objectives  To explore how parents communicate their preferences for antibiotics to their child's physician and to examine whether physicians can communicate why antibiotics are not being prescribed in a way that maintains satisfaction with the visit.

Design  Previsit survey of parents, audiotaping of the study encounters, and a postvisit survey of parents and physicians.

Setting  Two private pediatric practices.

Participants  Ten physicians (response rate = 77%) and a consecutive sample of 295 eligible parents (response rate = 86%) who attended acute care visits for their children between October 1996 and March 1997.

Main Outcome Measures  Physician-perceived pressure to prescribe antibiotics and parental visit-specific satisfaction.

Results  Fifty percent of parents expressed a previsit expectation for antibiotics. Among these parents, only 1% made a direct verbal request for them. Even when no direct requests for antibiotics were made, physicians still perceived an expectation for antibiotics 34% of the time. Among parents who did not receive expected antibiotics, those offered a contingency plan from the physician (ie, the possibility of receiving antibiotics in the future if their child did not get better) had a higher mean satisfaction score than parents not receiving a contingency plan (76 vs 58.9; P<.05).

Conclusion  Physicians should consider providing a contingency plan to parents who expect antibiotics for their children when there is no clinical indication. Further study is needed to determine how parents indirectly communicate their desire for antibiotics and what additional communication techniques physicians can use to resist the overprescribing of antibiotics.

From the Department of Pediatrics, University of California, Los Angeles (Dr Mangione-Smith); RAND, Santa Monica, Calif (Drs McGlynn, Elliott, and McDonald); and the Center for Health Services Research in Primary Care, University of California, Davis (Drs Franz and Kravitz).

Corresponding author and reprints: Rita Mangione-Smith, MD, MPH, UCLA Department of Pediatrics, 12-365 Marion Davies Children's Center, 10833 LeConte Ave, Los Angeles, CA 90095-1752 (e-mail: ritams{at}ucla.edu).

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