A 34-year-old man comes to the office with a 5-day history of nasal congestion and cough. He says that he occasionally coughs up thick, yellow sputum and is worried about the lack of improvement. The patient mentions that he has received antibiotics for similar symptoms in the past and says, "Antibiotics always seem to help me feel better fast." Temperature is 37.2 C (99 F), blood pressure is 120/70 mm Hg, pulse is 76/min, and respirations are 18/min. Physical examination shows pharyngeal erythema; the remainder of the examination, including cardiopulmonary evaluation, is normal. Which of the following responses by the physician is most appropriate?

Question

A 34-year-old man comes to the office with a 5-day history of nasal congestion and cough.  He says that he occasionally coughs up thick, yellow sputum and is worried about the lack of improvement.  The patient mentions that he has received antibiotics for similar symptoms in the past and says, "Antibiotics always seem to help me feel better fast."  Temperature is 37.2 C (99 F), blood pressure is 120/70 mm Hg, pulse is 76/min, and respirations are 18/min.  Physical examination shows pharyngeal erythema; the remainder of the examination, including cardiopulmonary evaluation, is normal.  Which of the following responses by the physician is most appropriate?

Quizplus · Accepted Answer

This afebrile patient with a normal lung examination most likely has a viral upper respiratory infection. The physician is faced with the common clinical issue of responding to a request for an unnecessary antibiotic prescription. Although many patients receive antibiotics for upper respiratory infections, antibiotic use in uncomplicated upper respiratory infections is associated with increased risk of adverse effects, no improvement compared to placebo, and a rise in antibiotic resistance. The most appropriate response is a patient-centered approach that validates the patient's concerns, educates the patient about the adverse effects of antibiotics and their lack of efficacy in treating viral infections, and provides options to treat the patient symptomatically. This must be done in an empathic and nonjudgmental fashion that helps build, not undermine, the physician-patient relationship. The physician should refrain from prescribing antibiotics and advise the patient to return if symptoms persist or worsen. (Choice A) This statement does not explain why antibiotics are not an appropriate treatment at this time and may be interpreted as dismissive given the patient's specific request. (Choice B) Although this may be true, it is not constructive to criticize previous treatment providers. (Choice D) Although it is appropriate to explain that unnecessary antibiotic use can contribute to general antibiotic resistance, this response is not patient centered because it dismisses the patient's concerns and does not explain why antibiotics are inappropriate for his specific symptoms. (Choice E) This statement fails to explain why antibiotics are inappropriate and does not offer any treatment options. It may be perceived as invalidating or judgmental and have a detrimental effect on the physician-patient relationship. Educational objective: Empiric antibiotic therapy for patients with uncomplicated upper respiratory infections is contraindicated. Responding to requests for inappropriate antibiotics involves a patient-centered approach that validates the patient's concerns, educates the patient about the adverse effects of antibiotics and their lack of efficacy in treating viral infections, and provides options to treat the patient symptomatically. __________ References: Patient-centered communication: basic skills. (http://www.ncbi.nlm.nih.gov/pubmed/28075109)

A 34-Year-Old Man Comes to the Office with a 5-Day