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Parental pressure for antibiotics can influence pediatricians' treatment decisions

When parents pressure pediatricians to prescribe antibiotics for their children, it can influence pediatricians' treatment decisions, according to a study supported by the Agency for Healthcare Research and Quality (HS10577). After using audiotapes and videotapes of 295 acute care visits to analyze the conversations of nine pediatricians and parents of pediatric patients, Tanya Stivers, Ph.D., of the University of California, Los Angeles, found that parents often pressured pediatricians to prescribe antibiotics for their children. What's more, this pressure prompted negotiation of antibiotic prescribing between parent and doctor. Doctors prescribed antibiotics for nearly half of all cases involving some form of overt pressure for antibiotics (15 out of 31 cases).

In six cases, a doctor who appeared to be on a clear path towards a viral diagnosis and no antibiotics, which are ineffective in treating viral infections, ended up prescribing antibiotics in the face of overt parental pressure. Parents used several approaches to pressure the pediatrician to defend his or her position not to prescribe antibiotics: directly expressing a preference for antibiotics, asking whether antibiotics should be considered in this case, citing circumstances such as need for the sick child to be well for an upcoming birthday party, or stating how antibiotics were prescribed for this condition before.

In response, pediatricians often found themselves explaining why antibiotics would not be appropriate, for example, for a simple cold or a case of influenza. However, in some cases, the parent refused to accept the doctor's perception of the case or diagnosis and persisted in wanting antibiotics. For example, one parent stated that the child's cold might actually be bronchitis, because the cough was so "congested." In some cases, the pediatrician finally acquiesced. For example, one doctor changed a child's diagnosis from a "cold" to sinusitis, for which antibiotics are more appropriate, even though he didn't fully endorse use of antibiotics in this case.

More details are in "Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters," by Dr. Stivers, in the April 2002 Social Science & Medicine 54(7), pp. 1111-1130.

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