Antibiotic prescribing and the primary care consultation
Prescribing antibiotics to patients who are unlikely to benefit remains common in primary care, and changing clinician behaviour and patient expectations has proved difficult. We suggest that part of the explanation lies with the dominant, «paternalistic model» of the physician-patient interaction. This model is no longer tenable, because for most patients, best treatment is controversial, management is inconsistent, physicians are not in the best position to evaluate trade-offs between management options without understanding patients' perspectives, and many pressures (apart from patients' agendas) intrude into the consultation. One alternative, the «informed model» of consulting, but this does not take society's interests into account. We propose that the «shared decision making model» provides a consultation framework that would promote the informed use of antibiotics in primary care.