Reposted from U of U Health.
More than a quarter of Americans have exaggerated or made up symptoms to try to get antibiotics from their doctor, either for themselves or for their children, a new study has found.
The survey of nearly 1,000 people nationwide uncovered common motivations for misrepresenting symptoms, including feeling very sick or needing to return to work or school.
The results indicate an urgent need for better communication between doctors and patients, so that patients can be confident that their symptoms are taken seriously and treated appropriately-whether or not that means antibiotics.
"Now that we have a clearer picture of how common these behaviors are and the reasons behind them, the next step is to look at strategies that help patients express their preferences and communicate what they're feeling to their provider, and for their provider to hear them, understand their concerns and reassure them," said co-lead author Alistair Thorpe, research assistant professor of population health sciences at University of Utah Health.
The results are published in JAMA Network Open (see below for links to both studies).
Severe illness and the need to return to work are common motivators
Among survey respondents, 28% said that they had deliberately misrepresented their symptoms to try to get antibiotics for themselves. A similar proportion, 27%, said that they had misrepresented symptoms to get antibiotics for a child in their care. This included cases in which a symptom was exaggerated or entirely made up.
People most commonly misrepresented symptoms because they felt very sick or felt that their child was very sick and believed that antibiotics were the only treatment that would work.
"It is a tough situation," Thorpe said. "People are experiencing unpleasant symptoms, and they can have this strong feeling that antibiotics are the only thing that can help them feel better. Being told to just rest and wait is a hard thing to do, and if you think there's something that could make you feel better, it's a very hard impulse to override."
Other respondents mentioned that they or their child needed to recover quickly to return to work or school, or cited a desire to control their own treatment path.
Why misrepresenting symptoms is dangerous
Antibiotics are effective and important treatments for bacterial infections but do nothing against viral infections-the most common cause of cold- or flu-like symptoms. And like any medication, antibiotics have a risk of side effects.
"These medications are not totally benign for the patient," said co-author Andrea Levy, professor of social sciences at Connecticut State Community College Middlesex. "And antibiotic use contributes to increasing antimicrobial resistance, which is a broader public health concern."
That means it's crucial for doctors to have a complete, accurate picture of patients' symptoms in order to prescribe antibiotics when they'll help-and avoid prescribing them when they might harm.
Blaming patients is not the way forward
The researchers emphasize that the goal of this research is not to blame people for misrepresenting symptoms. "There are very understandable reasons that we can sympathize with about why patients might feel the need to misrepresent symptoms, or why caregivers might do so on behalf of their children," Levy said. "We're simply saying: perhaps there's a better way."
Patients' reasons for misrepresenting symptoms are often grounded in past experiences. People were more likely to overstate symptoms if they had had their symptoms dismissed or downplayed by a doctor in the past, for instance.
Being incorrectly prescribed antibiotics for a prior viral infection can also lead to a powerful association between antibiotics and feeling better, Thorpe added. Viral infections usually clear up on their own, and it's easy for people to incorrectly credit antibiotics for their recovery.
The results show a need for better communication strategies for both doctors and patients, the researchers say. Doctors need ways to communicate with patients so they know they are heard and their symptoms are being taken seriously, even when antibiotics wouldn't help.
"Going forward, it will be important to test different ways to change the communication patterns between patients and their clinicians," said Angela Fagerlin, professor and chair of the U's Department of Population Health Sciences and senior author on the studies. "How can clinicians communicate to patients the importance of not prescribing antibiotics when they won't be effective, how can patients communicate in a way that their concerns and needs are met, and how can we help each other better understand the others' perspectives?"
"The practical takeaway is not for clinicians to become more suspicious of their patients," Levy added. "Instead, clinicians need to create interactions where caregivers and patients feel heard enough that they don't feel the need to exaggerate in order to be taken seriously."
"Patients regularly feel this way," Thorpe said. "It should be a priority for us to identify strategies for reassuring people, re-earning trust and finding the right ways to address their concerns. We want a long-term relationship between a patient and health care provider to be based on trust, openness, transparency and people having each other's best intentions in mind."
The results were published Oct. 30 in JAMA Network Open as "Symptom Misrepresentation to Obtain Antibiotics" and "Caregiver Symptom Misrepresentation to Obtain Antibiotics in Pediatric Encounters."
The work was funded by the University of Utah, the VA, the Veterans Health Administration, the Health Systems Research Service and the American Heart Association. Content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
