GPs’ reasons for “non-pharmacological” prescribing of antibiotics
A phenomenological study

Abstract

Objective To study the reasons cited by Icelandic general practitioners for their “non-pharmacological” prescribing of antibiotics. Design A qualitative interview study with research dialogues guided by the Vancouver School of doing phenomenology. Setting General practice. Participants A total of 16 general practitioners: 11 in the maximum variety sample and 5 in the theoretical sample. Results The most important reasons for prescribing antibiotics in situations with low pharmacological indications (non-pharmacological prescribing) were an unstable doctor–patient relationship due to lack of continuity of care, patient pressure in a stress-loaded society, the doctor's personal characteristics, particularly zeal and readiness to serve, and, finally, the insecurity and uncertainty of the doctor who falls back on the prescription as a coping strategy in a difficult situation. Conclusion The causes of non-pharmacological prescribing of antibiotics are highly varied, and relational factors in the interplay between the doctor and the patient are often a key factor. Therefore, it is of great importance for the general practitioner to know the patient and to become better equipped to resist patient pressure, in order to avoid the need to use the prescription as a coping strategy. Continuity of medical care and a stable doctor–patient relationship may be seen as the core concepts in this study and the most important task for the GPs is to promote the patients’ trust.

• Antibiotics
• coping
• general practitioners
• non- pharmacological prescribing
• phenomenology
• prescription habits

Concern has increased worldwide with regard to the over-prescribing of antibiotics, as well as the fact that more bacteria strains are developing resistance to antibiotics.

• Lack of continuity in medical care and an insecure relationship between doctor and patient together with shortage of time and patient pressure are the main reasons the respondents suggest for the issue of “non-pharmacological” prescriptions.

• Personal and emotional factors, such as the doctor's insecurity and anxiety, self-deception, tiredness, and the wish to avoid confrontation, give rise to questions as to whether non-pharmacological prescriptions function as a type of coping strategy.

• It is important for the general practitioner to know the patient and to become equipped to resist patient pressure.

Concern has increased worldwide with regard to the over-prescribing of antibiotics, as well as the fact that more bacteria strains are developing resistance to antibiotics.

• Lack of continuity in medical care and an insecure relationship between doctor and patient together with shortage of time and patient pressure are the main reasons the respondents suggest for the issue of “non-pharmacological” prescriptions.

• Personal and emotional factors, such as the doctor's insecurity and anxiety, self-deception, tiredness, and the wish to avoid confrontation, give rise to questions as to whether non-pharmacological prescriptions function as a type of coping strategy.

• It is important for the general practitioner to know the patient and to become equipped to resist patient pressure.