Parental expectations must be dealt with

EDITOR—The study by Damoiseaux et al adds greatly to the evidence that antibiotics are of limited use in children of all ages with uncomplicated otitis media.1 In consultations in general practice, however, the decision to prescribe is greatly influenced by considerations arising from the doctor-patient relationship.2 Often doctors find it difficult to convince worried parents that watchful waiting is acceptable treatment for their child.

Many parents see watchful waiting as no treatment and are disappointed by the outcome of the consultation. Sleepless nights, the effort spent in attending the surgery, previous experience, and views of relatives may all increase the expectation of treatment. The challenge in general practice is to present the evidence in such a way that parents feel empowered at the end of the consultation and more able to cope with the problems their children experience, rather than disempowered when their expectations are not met. General practitioners are faced with this dilemma every day. In their qualitative study of the reasons why antibiotics were prescribed for sore throats, Butler et al found that patients' expectations were seldom explicit, and many were not met.2 A third of patients clearly expected a prescription for antibiotics, but satisfaction was not necessarily related to receiving antibiotics, many patients instead seeking reassurance, further information, and pain relief. Educational campaigns may help to reassure parents,3 and general practitioners' confidence may be improved with the increasing use of decision aids in the surgery. These aids stimulate patients to be more active in decision making without increasing their anxiety, but unfortunately have little effect on satisfaction.4

Repeating the evidence for lack of effectiveness is unlikely to change doctors' prescribing. Instead, Butler et al concluded that information should be presented in terms of the risk to individual patients, emphasising the positive aspects …