GPs feel patient pressure for ‘unnecessary’ antibiotics: Poll

Often finding themselves on the frontline of antimicrobial stewardship, GPs say they are frequently left to explain to frustrated patients why antibiotics are not always the best treatment.
 
It can be a hard job when patients are sick or worried about themselves, or their children, and there is an increase in respiratory illnesses spreading in the community.
 
But, as one expert pointed out, this pressure has potential to erode the GP–patient relationship.
 
A recent newsGP poll asked RACGP members how often they feel pressure from patients to prescribe antibiotics that are not clinically necessary.
 
The results showed 26% of respondents have this experience on a daily basis, with a further 37% saying it occurs weekly.
 
An additional 20% said they had felt pressured at least once a month – with just 15% reporting it rarely happens or has not happened at all.
 
The poll results come after the issue was forced into the spotlight last month, with Australia’s Chief Medical Officer Professor Tony Lawler releasing a statement publicly warning people to stop putting pressure on GPs for antibiotics.
 
‘Antibiotics do not work on everything. They only treat certain bacteria under certain conditions. You should not take them “just in case”,’ he told patients.
 
RACGP Expert Committee – Quality Care member Dr Michael Tam told newsGP that while GPs are quite capable of standing steadfast against any undue pressure it does ‘become a point of tension’ and a ‘threat’ to the therapeutic relationship.
 
‘We don’t want to have arguments with patients that lead to them having a loss of trust and may affect the future care you can provide to that person,’ he said.
 
‘Most GPs actually cope with it fine, it would be better if we didn’t necessarily have to cope with it at the same frequency, but I think most GPs have their own ways of working through this.
 
‘For so many of my colleagues who experience it daily, or at least on a weekly basis, it can become quite a trying thing, especially during particular times of the year when many people may present with respiratory tract infections.’
 
An analysis by the Australian Commission on Safety and Quality in Health Care (ACSQHC) released late last year found the number of respiratory-related antimicrobial prescriptions still remains too high.
 
ACSQHC’s report stated hundreds of Australians are dying each year due to drug-resistant infections, which are exacerbated by overuse of antimicrobials, and that Australian community prescribing rates outstrip most other countries.
 
Dr Tam is concerned that the increased pathways in which people can get prescriptions, including online providers and pharmacy prescribing, could be posing greater risks.
 
‘With some of the potential changes in the configuration of the health system, particularly with potentially looser controls of prescribing, with perhaps less-experienced prescribers, I think there is an increased risk,’ he said.
 
However, that doesn’t necessarily mean there have not been improvements – as Dr Tam explains.
 
‘Things can definitely improve but they have improved before,’ he said.
 
‘Antimicrobial prescribing used to be relatively higher, and we have seen a drop over time as there has been a lot of work done over 10 or 20 years to really try to improve antimicrobial stewardship.’
 
According to a study published in the British Medical Journal, 44% of GPs surveyed admitted they had prescribed antibiotics to ‘get a patient to leave the surgery’, and 45% had prescribed antibiotics for a viral infection despite knowing they would not be effective.
 
And when surveying patients, the study found 4% of adults expected to have antibiotics prescribed every time they visited their GP, and 6% ‘on most occasions’, and 88% said their main reason for requesting antibiotics was to ‘get rid of an infection’.
 
But overall, Dr Tam believes people still come to their GP because they trust their opinions and, if given more time, they could understand more.
 
‘GPs, on the whole, want their patients to get better, they want to help their patients,’ he said.
 
‘We’re trying to work with whatever symptoms it is that they’re concerned about and making sure they feel supported and happy at the end of the consultation and that takes time in an environment where perhaps there isn’t a lot of time.
 
‘People come to see GPs because there is a genuine respect that they are coming with questions about their health, so it does become an opportunity as well, but it becomes increasingly challenging to have those conversations and give patients enough time so that there is a satisfactory resolution at the end of the visit.’
 
Dr Tam says ‘we need to take a wide view’ when looking for solutions.
 
‘A lot of this is rightly placed in primary care, because that’s where majority of all healthcare occurs, including antimicrobial prescribing, but at the same time, the usage of antimicrobials in secondary and tertiary training hospitals, there are pretty major problems there as well,’ he said.
 
‘Public health messaging is important, and I think that needs to be on an ongoing basis because it does then create the context in which patient–doctor conversations can be understood.’
 
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antibiotics antimicrobial resistance antimicrobials GP–patient relationship multi-drug-resistant organism