Communicating with Parents about Antibiotics A Guide for Physicians University of Kentucky Department of Communication
The University of Kentucky Department of Communication is grateful for the assistance of Dr. Don Cegala of The Ohio State University and is indebted to his research, upon which this publication is based. Funding to develop and evaluate the effectiveness of PACE for Parents and Pediatricians was provided by the Centers for Disease Control and Prevention (CDC; Directed Source 02054): Harrington NG, Norling GR, Witte F, Taylor JA, Andrews J. The effects of communication skills training on pediatricians’ and parents’ communication during “sick child” visits. Health Communication 2007;21:105-114. The content in this booklet is solely the responsibility of the authors and does not necessarily represent the official views of the CDC or the University of Kentucky.
Communicating with Parents about Antibiotics A Guide for Physicians University of Kentucky Department of Communication
Communicating about antibiotics Effective communication between parents and physicians leads to quality care and patient satisfaction.
Communicating with parents about the use of antibiotics can be challenging. Parents with a sick child are under stress during
visits to a doctor, and physicians are also under stress because
of busy appointment schedules. These stressors can combine to reduce the effectiveness of physician-parent communication. As a result, parents may not properly understand their child’s
condition or the treatment options that you suggest. Learning to use effective communication skills can help you better address parents’ concerns and provide better care for the child.
What can you do?
The parents’ goal for the medical visit is to help their child get
well as soon as possible. Therefore, they want you to provide an effective treatment, and they often believe that an antibiotic is
the “magic bullet” that will solve the problem quickly. You, on the
other hand, know that antibiotics are not always the solution and may even be harmful in the long run. How do you reconcile
these different viewpoints and provide the best care for the child
while also avoiding conflict with the parents? One way is through more effective communication using the PACE approach.
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P
Present treatment options in a positive manner
A
Acknowledge parents’ feelings, concerns, and expectations
C
Create a partnership
E
Encourage questions
Present treatment options in a positive manner
P
When their child is sick, parents often feel helpless. When they are told that the illness must simply “run its course,” their feelings of helplessness and stress increase and they become frustrated.
Physicians can help prevent this by telling the parents what they are going to do for the child instead of what they are not going to do
(prescribe an antibiotic). Research has shown that presenting the
treatment in a positive manner increases the likelihood that parents will comply with physicians’ recommendations and also increases parents’ feelings of satisfaction with the medical visit.1-7 For this
reason, the visit often runs more smoothly if physicians don’t even
mention antibiotics unless the parents bring up the subject. Instead, physicians might use the following techniques.
In the case of a runny nose and a cough, you might say this:
“An over-the-counter cold medicine three times a day and plenty of fluids will do the trick.”
In the case of an ear ache, you could say this:
“There’s some fluid in the middle ear. I know that makes her really uncomfortable. The best thing to do is to give her an over-the
counter pain reliever three times a day and have her rest in bed.” If the parents suggest that an antibiotic would help, it’s time for the physician to address the issue by explaining why the use of
antibiotics is not appropriate for the child’s condition. The physician might say something like this:
“It might seem like antibiotics would work for this, but they really
won’t. In fact, taking antibiotics when they’re not needed may be harmful and may make your child resistant to antibiotics when they are needed.”
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A
Acknowledge parents’ feelings, concerns, and expectations
Physicians sometimes perceive that parents want antibiotics for their child, whether or not the parents directly request these
medications during the medical visit. Studies comparing parents’
expectations with physicians’ perceptions have shown that these perceptions are often unfounded.1-7 Such misperceptions can be
avoided if the physician directly asks parents about their
expectations for the medical visit. Allowing parents to express their
expectations, feelings, and concerns gives physicians the opportunity to acknowledge those expectations and, if appropriate, to reassure the parents early on and throughout the visit.
Validating the feelings and concerns of the parents is also very
important in reducing the risk of misunderstandings and conflicts.
Physicians can validate parents’ feelings and concerns by recognizing and responding to them. Validation may include statements such as the following:
• “I can certainly understand why you’d be upset under the circumstances.”
• “Anyone would find this difficult.”
• “Your reactions are perfectly normal.”
• “This would be anxiety provoking for anyone.” • “I can understand why you’re so angry.”
Finally, physicians can show that they are concerned and interested
by listening carefully and attentively. The following actions can indicate to parents that the physician considers their statements important: • Pay attention and look at the parents as they are talking; don’t look at the clock.
• Lean forward slightly and sit (or stand) still.
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• Nod to indicate understanding.
• Summarize what you heard them say to check your understanding.
Create a partnership
C
Creating a partnership with parents lets them know that they can
have input into the medical visit and can influence what happens
to their child. Physicians can create a partnership with parents in a number of ways, including using statements and questions such as these:
• “I realize that this is a problem for you. Perhaps if we put our heads together, we might come up with some ideas.”
• “We’ll need to work together on this.”
• “What would you like to see happen?”
• “We’ve covered a lot. Do you have some questions?” Physicians can increase partnership-building by using language that parents can easily understand. Parents often don’t understand medical terminology or jargon, but sometimes they are too
intimidated to ask for clarification. If this happens, they may not
understand their child’s condition or the best treatment for it. Such
misunderstandings get in the way of building an effective partnership because they negatively affect compliance and increase frustration. Therefore, clear, simple language is best.
It is particularly important that parents understand what they can do to alleviate their child’s symptoms. Physicians can help by
recommending over-the-counter medications for pain or discomfort.
They can also reassure parents that they are not helpless to comfort their child.
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E
Encourage questions
Parents are often nervous and unwilling to ask questions of busy doctors. For this reason, physicians may need to prompt
questions and to engage the parents in discussion. Asking open-ended questions instead of yes-or-no questions can
encourage parents to discuss things that they don’t understand. Statements such as the following can be particularly effective: • “What questions do you have about the treatment?”
• “What else can I tell you about how to make your child feel more comfortable?”
Sometimes, parents will ask indirect (or disguised) questions in an attempt to seem less pushy. For example, they might make statements such as these:
• “The cough medicine doesn’t seem to relieve my child’s
coughing. I’ve tried different brands, but none of them seem
to help.” The parent may really be asking, “Can you give my child something that would work better?”
• “My child runs a low-grade fever sometimes, but I guess this is normal for a 2-year-old.” The parent may be asking, “Should I be worried?”
Physicians who listen for statements like these will often discover
that the statements disguise questions for which the parents need answers.
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A summary of helpful tips... • Tell parents what you can do to treat their child instead of what you won’t do.
• Be an active listener by paying close attention to the parents. • Don’t watch the clock.
• Encourage rapport by maintaining eye contact and making sure your tone of voice shows you are interested.
• Write down suggestions for comforting the child, so the parents have something to take with them.
• Use nontechnical language that the parents can understand. • Check for understanding by asking open-ended questions. • Encourage parents to ask questions throughout the visit. • Bring up antibiotics only if the parents do (in the case of illnesses that will not be helped by antibiotics).
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References 1. Bauchner H, Pelton S, Klein J. Parents, physicians, and antibiotic use. Pediatrics 1999;103:395-401.
2. Mangione-Smith R, McGlynn E, Elliot M, Krogstad P, Brook R.
The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 1999;103:711-718.
3. Mangione-Smith R, McGlynn E, Elliot M, McDonald L, Franz C, Kravitz R. Parent expectations for antibiotics,
physicians-parent communication, and satisfaction. Archives of Pediatric Adolescent Medicine 2001;155:800-806.
4. Mangione-Smith R, Stivers T, Elliot M, McDonald L, Heritage J. Online commentary during the physical examination: A
communication tool for avoiding inappropriate antibiotic
prescribing? Social Science & Medicine 2003;56:313-320.
5. Stivers T. Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric
encounters. Social Science & Medicine 2002; 54:1111-1130.
6. Stivers T. Presenting the problem in pediatric encounters: “Symptoms only.” “Candidate diagnosis” presentations. Health Communication 2002;14:299-338.
7. Stivers T, Mangione-Smith R, Elliot M, McDonald L. Why do physicians think parents expect antibiotics? What parents
report vs what physicians believe. Journal of Family Practice 2003;52:140-148.
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Notes
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