Discussing antibiotics with patients

C Concerns:

Ask specifically about patient’s concerns, do not solely rely on patient history. If concerns are not specifically asked about, the patient will sometimes not share their main worries for fear of being seen as ‘overly-anxious’.

There are probably a number of things that are worrying you about this illness, but what would you say are the things that you are most worried about?’

‘You’ve mentioned the high temperature; is that the thing that is causing you most worry at the moment, or is it something else?’

‘When you feel like this it can be pretty worrying, and I just want to make sure that I have a clear understanding of what you are most worried about at the moment. Is it the cough that is worrying you most? Or perhaps there is something else worrying you?’

H History & exam:

Discuss history & exam to help reassure patients that they are being listened to. While doing an examination provide a running commentary for example

“no problem”

“Your heart rate is normal, your temperature isn’t raised, your lungs sound good.”

E Expectations:

The only way of actually knowing what patients want or expect is to ask them. A 2021 survey of the general public found an increase in those expecting antibiotics from the GP compared to the previous year, however there was also an increase in those wanting information on whether or not they actually needed the expected antibiotic. A patient that appears ‘demanding’ may actually just want reassurance that the infection has not ‘gone down to the chest’, rather than antibiotics.

Consider asking the patient about the expectations

“How do you think I could most help you today?”

“How do you feel about antibiotics?”

S Symptoms:

Provide non-serious explanation for symptoms.

“Your body produces phlegm as a normal reaction to inflammation in the airways to your lungs.’”

“The phlegm catches particles in your airways and helps keep your lungs clear.”

T Timeline:

Be specific about illness timeline / usual course. A typical duration of common infections can be: Sore throat: 7-8 days | Sinusitis: 14-21 days | Cough or bronchitis: 21 days | Otitis media: 8 days | Common cold: 14 days

“A typical cough can take 3-4 weeks to clear completely.”

S Shortcomings:

Explain shortcomings of antibiotics:

‘Research shows that on average antibiotics may help reduce how long your cough lasts by only 1 day in an illness lasting 3–4 weeks.’

‘Antibiotics don’t help with pain but have side effects, such as diarrhoea, nausea and rash, which can be experienced by up to 1 in 10 people taking antibiotics.’

S Self-Care:

Advise patients how to self-care:

‘The immune system needs normal fluids to work properly, it is working hard to fight off the infection, so you need to make sure you are drinking enough – when people are unwell they often drink less without noticing.’

‘Pain in the chest or throat is normally due to inflammation, you can take paracetamol, and/or ibuprofen, which will help the pain and soothe the inflammation.’

See the TARGET leaflet section for more information on discussing safety-netting with patients.

S Safety-Netting:

Provide safety-netting advice, Provide patients with specific information on red-flag symptoms and when they should seek further help.

See the TARGET leaflet section for more information on discussing safety-netting with patients.