Acute cough: a qualitative analysis of how GPs manage the consultation when patients explicitly or implicitly expect antibiotic prescriptions

Objective. The aim of this study was to analyse how GPs manage the consultation for acute cough when patients explicitly or implicitly expect antibiotic prescriptions. Methods. A qualitative analysis of audio-taped consultations was carried out. The participants were eight GPs from eight general practices in Northrhine, Germany and their 42 patients with acute cough over a 2 week period. Three researchers analysed the consultations independently, finally agreed by discussion. Results. Implicit expectations for antibiotics were found frequently, but in none of the 42 consultations was the patient asked directly what she or he expected in terms of therapy. The topic of expectations and demands itself normally was not discussed at all, not even in a non-direct manner. In some consultations, the possibility of an antibiotic prescription was ruled out by the GP from the beginning. In some consultations, even a 'pseudo-consent' was found, avoiding any explicit clarification. Conclusion. GPs seem to overestimate the actual pressure to prescribe antibiotics for acute cough. The (over) prescription of antibiotics might not be a question of knowledge but a lack of patient centredness.