Communication is key for clinicians when it comes to viral illness

Clinicians tend to use language that minimises the severity of viral illness in children with respiratory tract infections (RTIs), a new study has found.

The University of Bristol study, funded by the Scientific Foundation Board of the Royal College of General Practitioners looked at communication between doctors and parents about antibiotic prescribing for children with cough.

It found clinicians' explanations of when they and didn't prescribe antibiotics contributed to the creation and reinforcement of parental beliefs that antibiotics were used when symptoms were more severe.

Dr Christie Cabral, from the Centre for Academic Primary Care, led the study. She said: "We looked at the communication in 60 primary care consultations for children with RTIs. We found a mutually-reinforcing cycle of explanation and discussion, where clinicians often talked about viral diagnoses in problem minimizing language, and antibiotic prescriptions in more problem-orientated language."

"This approach reinforces the belief that antibiotics are needed for more severe illness. Parents believe that illnesses are more severe when they have a greater impact on a child's life. In particular, illness that disrupts normal sleeping and eating patterns is perceived as severe. Clinicians rarely say anything explicit to challenge parental beliefs about what indicates illness severity, which means that when antibiotics are prescribed, parents' beliefs about what indicated severity can be reinforced."

The study also found that, while most parents' understanding of antibiotic resistance was poor, the majority supported reducing antibiotic prescribing and were happy to be reassured that their child did not need antibiotic treatment.

Dr Cabral said: "Our study found communication aimed at reducing parents' expectations of antibiotics being prescribed could be more effective. Clinicians could reduce expectation of antibiotic treatment for more severe appearing illness by highlighting that viral illnesses, such as bronchitis or viral pneumonia – for which antibiotics are not the answer – can be severe, and that healthy children will usually recover from bacterial respiratory infections without antibiotic treatment."

The study also suggests that clearer explanations of the symptoms and signs of a child's illness, which indicate when antibiotics are required or not, would help reduce misconceptions.

"Interventions to reduce antibiotic prescribing need to address in-consultation communication, prescribing behaviour and lay beliefs simultaneously," said Dr Cabral. "Combining these aspects is essential to avoid having one undermine the other."