Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to say no to inappropriate antibiotic requests

Dike Drummond, MD
Physician
March 27, 2012
Share
Tweet
Share

Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI … but not a single voice tells us how to do that.

Let me give you a three part structure you can use in your patient conversations in the future – and some exact words to try out.  This structure is adapted from the Parenting literature, another role where boundaries and inappropriate requests are common issues.

The Three “E”s

  • Empathize
  • Evaluate
  • Educate

Know from the start that there are several things going on inside the patient simultaneously. Each has two components:

  • a primary experience
  • a longing

And each of these must be addressed for the two of you to be comfortable at the end of the office visit.

1. Your patient is suffering

Their primary experience is misery.

Remember the last time you had a snotty cold, bad cough, chills and you missed work and all the kids were sick too? You waited 3 days to get over it and still felt terrible. You just have 2 days of sick leave left in the year and it’s only March. You’ve got the picture … yes?

Here is their longing.

They want to be heard. They yearn for your empathy, because they are not getting it from anyone else.

There is a saying that is 100% true in this situation: “They don’t care how much you know, until they know how much you care.”

Your job is to empathize first, show compassion, meet them in that shared place of suffering because you have been in that situation too.

Let me give you some specific phrases you might use:

“Wow, that sounds terrible.”

“You sound miserable, how are you holding up?”

“I hate it when that happens, you must be very frustrated.”

ADVERTISEMENT

“You poor thing, I am so sorry this is happening to you.”

If you have a major challenge working up some empathy one of two things is happening.

You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.

You are not fully present with the patient and their experience. In many cases this can be addressed by taking a big relaxing, releasing breath between each patient and consciously coming back into the present before opening the door.

2. Your patient is scared

Their primary experience is worrying that “something serious” is going on here … that this is more than just a cold and needs more than just chicken soup.

Here is their longing.

They want a doctor’s opinion so they get treated appropriately for what is really going on. They respect your knowledge and professional diagnosis.

Your job is to take a focused history , do a focused exam and give them a well reasoned diagnosis – no matter how many “cases like this” you have seen this week.

3. Your patient has an incorrect assumption of a solution

Their primary experience is one of thinking they know the solution and you are the source.

Their thought process might be:

“My phlegm is green, which means I need antibiotics” or “Larry down the hall got a “Z-Pack” for the same thing last week and now he is better. I must need one too.”

Their longing is to have something they can do to feel better.

The patient’s assumption is not only incorrect … it is potentially very dangerous. We are on solid ground here for a specific educational conversation.

Tell them what you know as a trained and experienced physician.

  • You have a viral URI … no question about it.
  • Here is the normal course of a URI.
  • Here’s what you can do to take care of yourself and speed the healing.
  • Antibiotics don’t make a difference in the course of a typical URI.
  • Antibiotics can cause diarrhea, yeast infections, allergic reactions and are a major cause of antibiotic resistant bacterial infections. Some of these complications can be fatal. We want to use antibiotics when we know they will work, otherwise the risks outweigh the benefits.
  • Here are the warning signs of a complication of a URI. If these happen, please come back in and let’s take another look.

Do this in words first and in a handout. Please don’t just hand them a lame, one-page handout and walk out of the room.

If the patient is still “demanding” antibiotics despite following the above conversation guidelines, this has become a boundary issue.  What are your boundaries around this inappropriate and potentially dangerous request?

Make sure to start with empathy first.

It could sound like this:

“I am so sorry you are feeling this way. And I understand how Larry down the hall got antibiotics last week and is better this week. I wish that would work in your case … and it won’t. 

“I won’t be writing a prescription for antibiotics because they would not help you and might cause a very serious complication. Here is information on how to get better and the signs that you are suffering a complication and need to be seen again.”

Persistent confrontational encounters with a specific patient are signs that the two of you are unable to establish and maintain a “therapeutic relationship”. This is solid grounds to enforce your boundaries again by asking them to find a different physician.

I encourage you to grab a partner — a colleague, friend, your spouse or significant other — and do the most productive thing possible to increase your skill in this important conversation.  Practice.

Have them be the sick person. You be the doctor.

Try out the phrases above and adapt them to your personal style. Then reverse roles … you play the patient. Reverse them again and be the doctor again.

Role play this until you are comfortable and your “empathy phrases” are second nature and true for you.

  • Empathy
  • Evaluate
  • Educate

Try these out for yourself.

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com. He teaches simple methods to help individual physicians and organizations recognize and prevent physician burnout. These tools were discovered and tested through Dr. Drummond’s 3,000+ hours of physician coaching experience. Since 2010, he has also delivered physician wellness training to over 40,000 doctors on behalf of 175 corporate and association clients on four continents. His current work is focused on the 7 Habits of Physician Wellbeing. Dr. Drummond has also trained 250 Physician Wellness Champions, and his Quadruple Aim Blueprint Corporate Physician Wellness Strategy is designed to launch all five components in a single onsite day. He can also be reached on Facebook, X @dikedrummond, and on his podcast, Physicians on Purpose.

Prev

A good thing we have mommy

March 27, 2012 Kevin 5
…
Next

Honesty is the basis of communicating with patients

March 27, 2012 Kevin 3
…

Tagged as: Infectious Disease

Post navigation

< Previous Post
A good thing we have mommy
Next Post >
Honesty is the basis of communicating with patients

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Dike Drummond, MD

  • Stop physician burnout: the hidden danger of AI note-writing software

    Dike Drummond, MD
  • Why resilience training alone won’t fix physician burnout

    Dike Drummond, MD
  • Ensure your physicians always have crisis support: 5-step awareness program

    Dike Drummond, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • Antibiotic resistance is the climate change of medicine

    Eric Beam, MD
  • How to help your patients understand antibiotic stewardship

    Greg Gafni-Pappas, DO
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • The black physician’s burden

    Naomi Tweyo Nkinsi
  • Why this physician supports Medicare for all

    Thad Salmon, MD

More in Physician

  • How scales of justice saved a doctor-patient relationship

    Neil Baum, MD
  • Rediscovering the soul of medicine in the quiet of a Sunday morning

    Syed Ahmad Moosa, MD
  • The broken health care system doesn’t have to break you

    Jessie Mahoney, MD
  • How a $75 million jet brought down America’s boldest doctor

    Arthur Lazarus, MD, MBA
  • The dreaded question: Do you have boys or girls?

    Pamela Adelstein, MD
  • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

    Muhamad Aly Rifai, MD
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
  • Recent Posts

    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Rediscovering the soul of medicine in the quiet of a Sunday morning

      Syed Ahmad Moosa, MD | Physician
    • An introduction to occupational and environmental medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Does silence as a faculty retention strategy in academic medicine and health sciences work?

      Sylk Sotto, EdD, MPS, MBA | Conditions
    • Why personal responsibility is not enough in the fight against nicotine addiction

      Travis Douglass, MD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 21 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
  • Recent Posts

    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Rediscovering the soul of medicine in the quiet of a Sunday morning

      Syed Ahmad Moosa, MD | Physician
    • An introduction to occupational and environmental medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Does silence as a faculty retention strategy in academic medicine and health sciences work?

      Sylk Sotto, EdD, MPS, MBA | Conditions
    • Why personal responsibility is not enough in the fight against nicotine addiction

      Travis Douglass, MD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How to say no to inappropriate antibiotic requests
21 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...