Doctors’ ways with words can lead to misperceptions

The way doctors describe medical conditions can drastically affect whether or not a patient demands antibiotics – even if they are not needed – according to a study conducted in the United States and published in Clinical Pediatrics this week.

Global research, including studies published in the New England Journal of Medicine and by the US Centers for Disease Control and Prevention (CDC), shows that more than half of all antibiotics prescribed are unnecessary. The CDC says this practice can lead to bacteria becoming drug resistant, leaving people infected with some resistant strains without effective treatment options.

The research focused on conjunctivitis, an eye infection more commonly known as pink eye and how the term “pink eye” affected people’s willingness to accept a doctor’s prescription.

The authors note that conjunctivitis is caused by bacteria, viruses or allergies but only bacterial infections will benefit from antibiotics.

The 159 parents who participated in the study were given scenarios to read that described a two-year-old child’s eye infection symptoms. The symptoms are usually associated with a viral infection and include “watery discharge and eye redness confined to the eyeball and small part of eyelid”.

Parents who were told that the condition was an “eye infection” were significantly more likely to accept the doctor’s recommendation that antibiotics were unnecessary.

But those who were told that the child had pink eye wanted antibiotics “regardless of whether they were told that antibiotics were ineffective or not”.

According to lead author Laura Scherer from the University of Missouri-Columbia, it is clear that “words matter” when doctors communicate with patients. “Likewise, our beliefs matter. Our study suggests that the words ‘pink eye’ makes parents believe the infection to be more contagious and to want medication even when it isn’t necessary.”

She says that these misperceptions “can potentially lead to overuse of antibiotics, which is causing increased antibiotic resistance”.

The authors note that past studies of primary care physicians found that doctors prescribe antibiotics in 70% to 90% of cases of eye infection, but research in 2008 in Acta Ophthalmologica shows that 50% to 70% of conjunctivitis cases in children are bacterial. 

Although antibiotic resistance is a worldwide problem, specific estimates for South Africa are not known.

Adrian Brink, a clinical microbiologist and co-chairperson of the South African Antimicrobial Stewardship Programme, which advocates the proper use of antibiotics to counter bacteria’s growing resistance to the drugs, previously told Bhekisisa that “South Africans love antibiotics.

“From a young age, we believe antibiotics will cure any illness. Doctors are to blame, too; they are the prescribers,” Brink said.

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Amy Green
Amy Green reported on health issues at the M&Gs health journalism centre, Bhekisisa, from 2013 to 2016.
Bhekisisa team
Bhekisisa Team
Health features and news from across Africa by Bhekisisa, the Mail & Guardian's health journalism centre.

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