How to say No when antibiotics won't help

Here are some proven techniques to persuade stubborn patients. New public education campaigns should also help.

By Ken Terry
Managed Care Editor

Internist Geoffrey H. Gordon recalls the stiff argument he got from a patient at the VA hospital in West Haven, CT. The doctor had declined to prescribe an antibiotic for the man's cold. "He was being really nasty about it, and it got my hackles up," says Gordon.

When the patient kept on, Gordon finally asked him why he was so insistent on getting an antibiotic. It turned out that while he was serving in the military, his mother had contracted pneumonia and died before he could return home. He'd been told that if she'd been seen sooner and had been put on an antibiotic, she might have survived. "He was angry and frightened about that."

After hearing his story, Gordon started writing the prescription, but the patient told him, "If you don't think I need it, that's fine."

This is one example of how to handle patients who demand antibiotics they don't need, notes Gordon, who's associate director of clinical education at the Bayer Institute for Health Care Communication. "You should ask, 'What would not getting this antibiotic mean for you? What concerns you the most about that?' "

But the tale also explains why many physicians avoid discussions about the dangers of overusing antibiotics: It takes too much time. When you combine patients' desire for antibiotics with the economic pressures to see more patients, some doctors would rather just write the prescription.