Increased and unmanageable use of antibiotics antibiotic is a major cause of antibiotic resistance and it poses a major threat to global health. According to a study published by American Psychological Association in Washington,'' Physicians are more likely to prescribe antibiotics when they believe there is a high expectation of it from their patients, even if they think the probability of bacterial infection is low and antibiotics would not be effective''.  Miroslav Sirota, PhD, The University of Essex and lead author of study exclaimed that, “Much effort has been spent encouraging physicians to adhere to clinical guidelines when prescribing antibiotics. However, with few notable exceptions, these efforts rarely address the nonclinical factors, such as how to tackle patient's expectations”. This study is published in the journal Psychology. This study depends on two experiments conducted on 436 physicians in the United Kingdom to check the dose of antibiotics prescribed by doctors.

In the first experiment, a questionnaire was filled by practicing family physicians (50 percent male) from around the U.K.  presented along with them with one of several different experimental episodes. All the experimental episodes include a 15-year-old girl who is suffering from a typical ear infection and she was also accompanied by her mother. She is on her third day of symptoms of a typical ear infection with fever, ear pain and reduced hearing but there is no ear perforation or discharge. In this study two expectations occur. In one version, the mother demanded from the doctor to help the girl in recovering quickly because she has to participate in an important swim meet in four days (high expectations condition). The another version does not demand quick recovery as there is no upcoming swim meet because the girl has already finished her swimming season (low expectations condition). According to above expectations the physicians examined the probability of a bacterial infection and then they conveyed their desire for antibody prescription on a scale of zero to 10. Ear infections can be either bacterial (which may respond to antibiotics) or viral (which don’t respond to antibiotic) and physicians can safely withhold or delay antibiotics unless the child is systematically unwell, has perforation and/or discharge in the ear canal, or if the symptoms have persisted for four days or more, in accordance with U.K. guidelines, which is in line with the U.S. and Canadian guidelines. An order of the questions was manipulated and presented before each participant, so that some received the bacterial probability question first and then the question on antibody prescription and others vice versa. Overall, despite the order of the questions, physicians who read the vignette where the mother had higher expectations for antibiotics prescribed them even though they were no more likely than physicians in the low expectations group to think the infection was bacterial.

“This was a somewhat reassuring finding as we thought that the effect of nonclinical factors might have been even more serious than we had imagined. Imagine, for example, that a physician rationalized her decision to prescribe the antibiotics by increasing the perceived probability of a bacterial infection. We did not find any evidence of that happening, which is good news, and has taught us something new about the localized effect of expectations.” said Sirota.

The second experiment episode includes story of an adult patient with ear infection symptoms who either had low or high expectations for antibiotics similar to first experimental episode. In this situation about 52% of physicians prescribed antibiotics and more likely if patients expected it. There was no distinction between the doctor’s reports of bacterial probability and antibiotics prescription as described in the previous experiment. Another experimental episode was carried out with adult patient who is suffering from typical cold and expected to had high expectations for antibiotics. Only 12 % of physicians prescribed antibiotics in the above case.

Sirota stressed that, “We do not intend our study to criticize physicians and how they prescribe antibiotics. Rather, we want to point out that the over prescribing of antibiotics is a serious systemic issue: we should all work together, from patients having more realistic expectations about antibiotic effectiveness to physicians managing patients’ expectations when contradicting clinical guidelines to tackle its multiple facets.”